Healthcare Provider Details

I. General information

NPI: 1386640100
Provider Name (Legal Business Name): NICK JOHN PIAZZA PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HARROUN RD
SYLVANIA OH
43560-2182
US

IV. Provider business mailing address

5300 HARROUN RD
SYLVANIA OH
43560-2182
US

V. Phone/Fax

Practice location:
  • Phone: 419-284-1100
  • Fax: 419-824-1778
Mailing address:
  • Phone: 419-284-1100
  • Fax: 419-824-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4018
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: