MEDICARE: MRS. PATRICIA ANN GIANNOS LISW LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	933466	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	1041C0700X	Clinical Social Worker	10002884	OH

General Provider Information

NPI Number	:	1205999505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN GIANNOS LISW LICDC

Provider Business Mailing Address
First Line	:	4319 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1663
Country	:	US
Telephone Number	:	330-492-2006
Fax Number	:	330-492-2161

Provider Business Practice Location Address
First Line	:	4319 HILLS AND DALES RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44708-1663
Country	:	US
Telephone Number	:	330-492-2006
Fax Number	:	330-492-2161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/17/2020

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