Provider Demographics
NPI:1841531431
Name:GIACOMANTONIO, MELISSA RUTH (BS/LBSW/QMRP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RUTH
Last Name:GIACOMANTONIO
Suffix:
Gender:F
Credentials:BS/LBSW/QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-4054
Mailing Address - Country:US
Mailing Address - Phone:810-232-6081
Mailing Address - Fax:
Practice Address - Street 1:2811 E COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-4054
Practice Address - Country:US
Practice Address - Phone:810-232-6081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801076355171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator