Provider Demographics
NPI:1366583502
Name:GIANNOSA, BETH ANN
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:GIANNOSA
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 1:46360 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2800
Mailing Address - Country:US
Mailing Address - Phone:586-948-0222
Mailing Address - Fax:586-948-0213
Practice Address - Street 1:46360 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2800
Practice Address - Country:US
Practice Address - Phone:586-948-0222
Practice Address - Fax:586-948-0213
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL6801076349104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker