MEDICARE: DR. JEANNE MARIE PIETTE

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	103TC0700X	Clinical Psychologist	PSY1000742	DC
2	103TC0700X	Clinical Psychologist	071005979	IL

General Provider Information

NPI Number	:	1679643746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNE MARIE PIETTE

Provider Business Mailing Address
First Line	:	2031 PAISLEY CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-4453
Country	:	US
Telephone Number	:	312-307-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 ALBEMARLE ST NW
Second Line	:	SUITE #504
City	:	WASHINGTON
State	:	DC
Zip	:	20016-1851
Country	:	US
Telephone Number	:	312-307-1814
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	05/18/2012

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