Provider Demographics
NPI:1861284861
Name:PIAZZA, JACLYN ANNE
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANNE
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8420 11TH AVE # A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3206
Mailing Address - Country:US
Mailing Address - Phone:646-879-5424
Mailing Address - Fax:646-879-5424
Practice Address - Street 1:506 GRAVESEND NECK RD FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4847
Practice Address - Country:US
Practice Address - Phone:917-392-4009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency