Provider Demographics
NPI:1477695989
Name:MIGNANELLI, GIOVANNI (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:MIGNANELLI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:MIGNANELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:75 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4905
Mailing Address - Country:US
Mailing Address - Phone:516-770-3842
Mailing Address - Fax:
Practice Address - Street 1:75 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4905
Practice Address - Country:US
Practice Address - Phone:516-799-3203
Practice Address - Fax:516-799-3081
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker