Provider Demographics
NPI:1982978359
Name:GIACONA, MARY ANNE (THM)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:GIACONA
Suffix:
Gender:F
Credentials:THM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2157
Mailing Address - Country:US
Mailing Address - Phone:315-704-0319
Mailing Address - Fax:315-704-0319
Practice Address - Street 1:1 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2157
Practice Address - Country:US
Practice Address - Phone:315-704-0319
Practice Address - Fax:315-704-0319
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral