MEDICARE: PIECING SOLUTIONS TOGETHER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW-13586	AZ

General Provider Information

NPI Number	:	1013459593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIECING SOLUTIONS TOGETHER, LLC

Provider Business Mailing Address
First Line	:	10882 E ESCALANTE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85730-5504
Country	:	US
Telephone Number	:	520-833-4290
Fax Number	:

Provider Business Practice Location Address
First Line	:	10501 E SEVEN GENERATIONS WAY
Second Line	:	STE 121
City	:	TUCSON
State	:	AZ
Zip	:	85747-5828
Country	:	US
Telephone Number	:	520-833-4290
Fax Number	:

Authorized Official
Title or Position	:	BILLING COORDINATOR
Name	:	MISS NICOLE LEE PETERSON
Credential	:
Telephone Number	:	520-441-4754

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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