Provider Demographics
NPI:1659779320
Name:VITULLO-COURNOYER, GIOVANNA
Entity Type:Individual
Prefix:DR
First Name:GIOVANNA
Middle Name:
Last Name:VITULLO-COURNOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:GIOVANNA
Other - Middle Name:
Other - Last Name:VITULLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:900 NORTH SHORE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2225
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 NORTH SHORE DR STE 120
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2225
Practice Address - Country:US
Practice Address - Phone:847-615-1698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009002103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist