Healthcare Provider Details

I. General information

NPI: 1639203938
Provider Name (Legal Business Name): DIANA M GIOVAGNOLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 N BROADWAY
WIND GAP PA
18091-1274
US

IV. Provider business mailing address

PO BOX 682
POCONO SUMMIT PA
18346-0682
US

V. Phone/Fax

Practice location:
  • Phone: 570-369-6865
  • Fax:
Mailing address:
  • Phone: 570-369-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016864
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW124168
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: