Provider Demographics
NPI:1700199965
Name:GIANFAGNA, CRISTINA
Entity Type:Individual
Prefix:MISS
First Name:CRISTINA
Middle Name:
Last Name:GIANFAGNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 DEEPWOOD BLVD
Mailing Address - Street 2:APT 22
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7774
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8030 DEEPWOOD BLVD
Practice Address - Street 2:APT. 22
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7774
Practice Address - Country:US
Practice Address - Phone:440-283-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34-6573631OtherUNKNOWN