Healthcare Provider Details

I. General information

NPI: 1932701562
Provider Name (Legal Business Name): ANDREA PIAZZA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 MONTGOMERY RD UNIT 513
ALTAMONTE SPRINGS FL
32714-7420
US

IV. Provider business mailing address

1070 MONTGOMERY RD UNIT 513
ALTAMONTE SPRINGS FL
32714-7420
US

V. Phone/Fax

Practice location:
  • Phone: 813-690-5092
  • Fax:
Mailing address:
  • Phone: 813-690-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0020485
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: