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General NPI Number Information
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NPI Number | 1679018329
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Entity Type | Organization
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Legal Business Name | DIANE PISZKER
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 23854 WALLOON WAY
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City | BROWNSTOWN
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State | MI
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Zip | 48134-8307
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Country | US
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Telephone | 313-418-2285
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 GRINDLEY PARK ST SUITE 3
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City | DEARBORN
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State | MI
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Zip | 48124-2553
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Country | US
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Telephone | 313-418-2285
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOTHERAPIST
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Name | MRS. DIANE PISZKER
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Credential | LMSW-C, SSW
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Telephone | 313-418-2285
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801085966
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License Number State | MI
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