Healthcare Provider Details

I. General information

NPI: 1932985694
Provider Name (Legal Business Name): SERENA PIASINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W WACKERLY ST STE 11
MIDLAND MI
48640-2769
US

IV. Provider business mailing address

818 EDGEWOOD DR APT 3
MT PLEASANT MI
48858-4181
US

V. Phone/Fax

Practice location:
  • Phone: 989-832-2165
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6352000909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: