Provider Demographics
NPI:1982882965
Name:PISTORELLO, JACQUELINE (PHD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:PISTORELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 GEAR ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2729
Mailing Address - Country:US
Mailing Address - Phone:775-846-5540
Mailing Address - Fax:
Practice Address - Street 1:MAIL STOP 0080
Practice Address - Street 2:UNIVERSITY OF NEVADA, RENO
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89557-0001
Practice Address - Country:US
Practice Address - Phone:775-682-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0408103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical