Provider Demographics
NPI:1760865828
Name:GIACOMELLI, JODI (PHD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:GIACOMELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5965 CREST DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3211
Mailing Address - Country:US
Mailing Address - Phone:814-449-9323
Mailing Address - Fax:
Practice Address - Street 1:5965 CREST DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3211
Practice Address - Country:US
Practice Address - Phone:814-449-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001030101YP2500X
PAPS017839103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional