Provider Demographics
NPI:1225074339
Name:GIOVANNETTI, RICHARD L (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:GIOVANNETTI
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2614
Mailing Address - Country:US
Mailing Address - Phone:320-252-5010
Mailing Address - Fax:320-203-1855
Practice Address - Street 1:253 8TH ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1598
Practice Address - Country:US
Practice Address - Phone:763-441-3770
Practice Address - Fax:763-441-9057
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11153104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
110623C851OtherUCARE
922241022711OtherPREFERRED ONE
19813OtherOPTUM
MN675022200Medicaid
HP25258OtherHEALTH PARTNERS
6204533OtherMEDICA
7H616GIOtherBCBS
6204533OtherMEDICA