Provider Demographics
NPI:1891130928
Name:PIECHOCKI, IRIDE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:IRIDE
Middle Name:
Last Name:PIECHOCKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRANITE WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5747
Mailing Address - Country:US
Mailing Address - Phone:207-712-5803
Mailing Address - Fax:
Practice Address - Street 1:20 GRANITE WAY
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5747
Practice Address - Country:US
Practice Address - Phone:207-712-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool