Provider Demographics
NPI:1992721716
Name:PIAZZA, CATHERINE JOAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JOAN
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:JOAN
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSCSW
Mailing Address - Street 1:14840 TRACE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-9026
Mailing Address - Country:US
Mailing Address - Phone:479-856-9541
Mailing Address - Fax:
Practice Address - Street 1:703 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-3205
Practice Address - Country:US
Practice Address - Phone:479-856-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW11581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100307170BMedicaid
KS068579OtherBLUE CROSS BLUE SHIELD
R76139Medicare UPIN