Provider Demographics
NPI:1003530601
Name:DIGIOVANNA, MARY ELIZABETH (LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DIGIOVANNA
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 STATE ST
Mailing Address - Street 2:
Mailing Address - City:TULLY
Mailing Address - State:NY
Mailing Address - Zip Code:13159-3218
Mailing Address - Country:US
Mailing Address - Phone:607-423-4831
Mailing Address - Fax:
Practice Address - Street 1:31 STATE ST
Practice Address - Street 2:
Practice Address - City:TULLY
Practice Address - State:NY
Practice Address - Zip Code:13159-3218
Practice Address - Country:US
Practice Address - Phone:607-423-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010207101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health