Provider Demographics
NPI:1982314068
Name:CONGIUSTA, GIANA L (LLMSW)
Entity Type:Individual
Prefix:
First Name:GIANA
Middle Name:L
Last Name:CONGIUSTA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GOLDSMITH DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1727
Mailing Address - Country:US
Mailing Address - Phone:908-427-4949
Mailing Address - Fax:
Practice Address - Street 1:103 E LIBERTY ST STE 203
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2136
Practice Address - Country:US
Practice Address - Phone:810-410-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851111003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6851111003OtherLICENSE