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General NPI Number Information
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NPI Number | 1871258871
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Entity Type | Individual
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Provider Name | TINA M CIEZKOWSKI L.P.C.M.H
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Gender | Female
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 3751 E PORTOLA VALLEY DR
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City | GILBERT
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State | AZ
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Zip | 85297-7876
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Country | US
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Telephone | 516-376-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 3751 E PORTOLA VALLEY DR
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City | GILBERT
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State | AZ
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Zip | 85297-7876
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Country | US
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Telephone | 516-376-1099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State | AZ
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