Provider Demographics
NPI:1932478021
Name:GIANNAMORE, MARY E (MA CCC, SLP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:GIANNAMORE
Suffix:
Gender:F
Credentials:MA CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 CASTAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2463
Mailing Address - Country:US
Mailing Address - Phone:772-563-7242
Mailing Address - Fax:
Practice Address - Street 1:1060 6TH AVE
Practice Address - Street 2:SUITES 2 & 3
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5922
Practice Address - Country:US
Practice Address - Phone:772-563-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist