MEDICARE: TIANA C PISTILLO

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	104100000X	Social Worker	12068	CT

General Provider Information

NPI Number	:	1972450534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA C PISTILLO

Provider Business Mailing Address
First Line	:	101 WEBER HILL RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1831
Country	:	US
Telephone Number	:	914-262-0842
Fax Number	:

Provider Business Practice Location Address
First Line	:	666 GLENBROOK RD STE LLC
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06906-1439
Country	:	US
Telephone Number	:	203-424-9934
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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