MEDICARE: DR. JOANNA MARY DRINANE PH.D.

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	101Y00000X	Counselor
2	103TC1900X	Counseling Psychologist
3	103TC1900X	Counseling Psychologist	11450397-2501	UT

General Provider Information

NPI Number	:	1902230667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNA MARY DRINANE PH.D.

Provider Business Mailing Address
First Line	:	1721 E CAMPUS CENTER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-8914
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 E CAMPUS CENTER DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-8914
Country	:	US
Telephone Number	:	845-323-1467
Fax Number	:

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

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	07/15/2022

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