Provider Demographics
NPI:1740012459
Name:PISCITELLI, STEFAN
Entity type:Individual
Prefix:
First Name:STEFAN
Middle Name:
Last Name:PISCITELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 BLOOD BROOK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLEE
Mailing Address - State:VT
Mailing Address - Zip Code:05045-9847
Mailing Address - Country:US
Mailing Address - Phone:267-370-4465
Mailing Address - Fax:
Practice Address - Street 1:1461 BLOOD BROOK RD
Practice Address - Street 2:
Practice Address - City:FAIRLEE
Practice Address - State:VT
Practice Address - Zip Code:05045-9847
Practice Address - Country:US
Practice Address - Phone:267-370-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health