Provider Demographics
NPI:1790155075
Name:SAM PIOTROWSKI, M.A., PLC
Entity Type:Organization
Organization Name:SAM PIOTROWSKI, M.A., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST - MASTER
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIOTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:802-598-7298
Mailing Address - Street 1:168 BATTERY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5285
Mailing Address - Country:US
Mailing Address - Phone:802-598-7298
Mailing Address - Fax:
Practice Address - Street 1:168 BATTERY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5285
Practice Address - Country:US
Practice Address - Phone:802-598-7298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0100524103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1023943Medicaid