Healthcare Provider Details

I. General information

NPI: 1922701275
Provider Name (Legal Business Name): JUSTINE PIONTEK MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S DAMEN AVE
CHICAGO IL
60612-3728
US

IV. Provider business mailing address

3017 W BELDEN AVE APT 3
CHICAGO IL
60647-5790
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-8387
  • Fax:
Mailing address:
  • Phone: 206-335-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP.08975
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP.08975
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberP.08975
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP.08975
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: