Healthcare Provider Details

I. General information

NPI: 1154788271
Provider Name (Legal Business Name): CARMELA NOTARIANNI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 S 8500 W
MAGNA UT
84044-1307
US

IV. Provider business mailing address

7936 W SHEVA CIR
MAGNA UT
84044-4405
US

V. Phone/Fax

Practice location:
  • Phone: 801-990-4300
  • Fax: 801-967-2127
Mailing address:
  • Phone: 801-518-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number218905-6006
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number218905-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: