Healthcare Provider Details

I. General information

NPI: 1205753647
Provider Name (Legal Business Name): GIACOMUCCI & WALKER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

IV. Provider business mailing address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

V. Phone/Fax

Practice location:
  • Phone: 484-440-9416
  • Fax:
Mailing address:
  • Phone: 484-440-9416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GIACOMUCCI
Title or Position: OWNER
Credential:
Phone: 484-440-9416