Provider Demographics
NPI:1497055776
Name:DIGIORGIANNI, JESS MICHAEL (MA, PHD, LCMHC)
Entity Type:Individual
Prefix:DR
First Name:JESS
Middle Name:MICHAEL
Last Name:DIGIORGIANNI
Suffix:
Gender:M
Credentials:MA, PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5284
Mailing Address - Country:US
Mailing Address - Phone:802-865-3450
Mailing Address - Fax:802-860-5011
Practice Address - Street 1:112 LAKE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5284
Practice Address - Country:US
Practice Address - Phone:802-865-3450
Practice Address - Fax:802-860-5011
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680064700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health