Healthcare Provider Details

I. General information

NPI: 1093808461
Provider Name (Legal Business Name): THOMAS S PIETROGALLO MSW/LCSW, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 BISCAYNE BLVD
MIAMI FL
33137-3840
US

IV. Provider business mailing address

3510 BISCAYNE BLVD
MIAMI FL
33137-3840
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-1234
  • Fax: 305-571-2020
Mailing address:
  • Phone: 305-576-1234
  • Fax: 305-571-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: