Healthcare Provider Details

I. General information

NPI: 1154382000
Provider Name (Legal Business Name): CAROL L. GIANELO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROL LORRAINE COULTER

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 S 1100 E
SALT LAKE CITY UT
84105-2432
US

IV. Provider business mailing address

81 SOUTH SKYCREST LN
SALT LAKE CITY UT
84108-1604
US

V. Phone/Fax

Practice location:
  • Phone: 801-205-4890
  • Fax: 801-521-0311
Mailing address:
  • Phone: 801-205-4890
  • Fax: 801-521-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number370522-3502
License Number StateUT

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: