Provider Demographics
NPI:1952480394
Name:GIANNETTI, MARIE L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:GIANNETTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ROUTE 134
Mailing Address - Street 2:TOWNE PLAZA 1-6
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2575
Mailing Address - Country:US
Mailing Address - Phone:508-385-4500
Mailing Address - Fax:508-385-4577
Practice Address - Street 1:900 ROUTE 134
Practice Address - Street 2:TOWNE PLAZA 1-6
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2575
Practice Address - Country:US
Practice Address - Phone:508-385-4500
Practice Address - Fax:508-385-4577
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7985514OtherAETNA
NYP08163OtherBCBS
MAP08163OtherMEDEX
MA015498OtherVALUE OPTIONS HPHC
NC7985514OtherAETNA
PA7985514OtherAETNA
MN2208702OtherCIGNA
KY7985514OtherAETNA
NY488810OtherVALUE OPTIONS
CT7985514OtherAETNA
MAP08163OtherBCBS
CA7985514OtherAETNA
MAP23074Medicare ID - Type UnspecifiedPART B