Provider Demographics
NPI:1841996352
Name:IANNONE, GINAMARIE PAMELA
Entity type:Individual
Prefix:
First Name:GINAMARIE
Middle Name:PAMELA
Last Name:IANNONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BRIXTON LN
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2104
Mailing Address - Country:US
Mailing Address - Phone:585-615-0012
Mailing Address - Fax:
Practice Address - Street 1:2060 HIGHWAY A1A STE 304
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3596
Practice Address - Country:US
Practice Address - Phone:321-574-6073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW202371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical