MEDICARE: TANIA GIOVANNETTI PHD

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	103G00000X	Clinical Neuropsychologist	PS015579	PA

General Provider Information

NPI Number	:	1235490475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA GIOVANNETTI PHD

Provider Business Mailing Address
First Line	:	2012 OGDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N 13TH ST
Second Line	:	TEMPLE UNIVERSITY, WEISS HALL PSYCHOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-6011
Country	:	US
Telephone Number	:	215-204-4296
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	06/05/2012

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