Provider Demographics
NPI:1437161270
Name:GIANNITELLI, ANGELO (DMIN)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:GIANNITELLI
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5406
Mailing Address - Country:US
Mailing Address - Phone:765-966-7586
Mailing Address - Fax:
Practice Address - Street 1:216 S 4TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5406
Practice Address - Country:US
Practice Address - Phone:765-966-7586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002900A1041C0700X
IN35000287A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist