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NPI Code Detail

MEDICARE: MS. ROBERTA MARIE PIETA LCSW

MEDICARE: MS. ROBERTA MARIE PIETA 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
11041C0700XClinical Social Worker149006276IL

General Provider Information

NPI Number : 1740771740
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROBERTA MARIE PIETA LCSW
Provider Business Mailing Address
First Line : 6639 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-4161
Country : US
Telephone Number : 312-673-2759
Fax Number :
Provider Business Practice Location Address
First Line : 6639 N KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-4161
Country : US
Telephone Number : 312-673-2759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2018
Last Update Date : 05/24/2018

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