Provider Demographics
NPI:1982247284
Name:GIOVANNIELLO, JESSICA ROSE (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:GIOVANNIELLO
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2917
Mailing Address - Country:US
Mailing Address - Phone:516-808-7515
Mailing Address - Fax:
Practice Address - Street 1:322 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2917
Practice Address - Country:US
Practice Address - Phone:516-808-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist