Provider Demographics
NPI:1295588648
Name:SANON, GIOVANNI ROSSINI
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:ROSSINI
Last Name:SANON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4294
Mailing Address - Country:US
Mailing Address - Phone:774-442-0069
Mailing Address - Fax:
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4177
Practice Address - Country:US
Practice Address - Phone:781-885-0277
Practice Address - Fax:781-885-0769
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health