Healthcare Provider Details

I. General information

NPI: 1053557652
Provider Name (Legal Business Name): NANCY PIERDIPINO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BLUE GRASS CIR
GUYTON GA
31312-5536
US

IV. Provider business mailing address

106 BLUE GRASS CIR
GUYTON GA
31312-5536
US

V. Phone/Fax

Practice location:
  • Phone: 917-750-7462
  • Fax:
Mailing address:
  • Phone: 917-750-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000779
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: