Healthcare Provider Details

I. General information

NPI: 1427599141
Provider Name (Legal Business Name): ELIZA PIOMELLI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZA ALICIA LOPEZ

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

IV. Provider business mailing address

1351 NEWTOWN PIKE DEPT 100
LEXINGTON KY
40511-1275
US

V. Phone/Fax

Practice location:
  • Phone: 423-587-7337
  • Fax: 423-586-0614
Mailing address:
  • Phone: 859-253-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: