Provider Demographics
NPI:1811106065
Name:GIACOMO, LINDA C (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:C
Last Name:GIACOMO
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 1:401 GROVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3219
Mailing Address - Country:US
Mailing Address - Phone:612-872-1161
Mailing Address - Fax:
Practice Address - Street 1:401 GROVELAND AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3219
Practice Address - Country:US
Practice Address - Phone:612-872-1161
Practice Address - Fax:612-871-7869
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP-1767103T00000X, 103TC0700X, 103TC2200X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN93551OtherHEALTH PARTNERS
MN66549OtherPREFERRED ONE CH PLAN
MN61-80064OtherMEDICA
MN61-80064OtherUNITED BEHAVIORAL HEALTH
MN47817GIOtherBLUE CROSS BLUE SHIELD MN
MN680001785Medicare ID - Type UnspecifiedMEDICARE PART B