MEDICARE: JOEL PIETSCH LCSW

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	SW 7509	FL

General Provider Information

NPI Number	:	1528310802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL PIETSCH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 10503
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33679-0503
Country	:	US
Telephone Number	:	813-486-0114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3839 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-2719
Country	:	US
Telephone Number	:	813-486-0114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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Directions to “ JOEL PIETSCH LCSW” Practice Location

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