Provider Demographics
NPI:1205999505
Name:GIANNOS, PATRICIA ANN (LISW LICDC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:GIANNOS
Suffix:
Gender:F
Credentials:LISW LICDC
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:MARKOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:4319 HILLS AND DALES RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-1663
Mailing Address - Country:US
Mailing Address - Phone:330-492-2006
Mailing Address - Fax:330-492-2161
Practice Address - Street 1:4319 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1663
Practice Address - Country:US
Practice Address - Phone:330-492-2006
Practice Address - Fax:330-492-2161
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH933466101YA0400X
101YA0400X
OH100028841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGISW04613Medicare ID - Type Unspecified