MEDICARE: JEANNE EVELYN PIZZAGRANI I

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1548891740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE EVELYN PIZZAGRANI I

Provider Business Mailing Address
First Line	:	2355 LANCASTER DR APT 7
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-3046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 LANCASTER DR APT 7
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-3046
Country	:	US
Telephone Number	:	479-459-3343
Fax Number	:

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

Provider Enumeration Date	:	01/28/2020
Last Update Date	:	01/28/2020

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