Provider Demographics
NPI:1396973582
Name:GIACOMUZZI, ANDREA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:GIACOMUZZI
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 1:12209 S AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1941
Mailing Address - Country:US
Mailing Address - Phone:623-386-0773
Mailing Address - Fax:
Practice Address - Street 1:12209 S AIRPORT RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1941
Practice Address - Country:US
Practice Address - Phone:623-386-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1058488103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst