MEDICARE: MARY ELIZABETH DIGIOVANNA LMHC, NCC

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	101YM0800X	Mental Health Counselor	010207	NY

General Provider Information

NPI Number	:	1003530601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH DIGIOVANNA LMHC, NCC

Provider Business Mailing Address
First Line	:	31 STATE ST
Second Line	:
City	:	TULLY
State	:	NY
Zip	:	13159-3218
Country	:	US
Telephone Number	:	607-423-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 STATE ST
Second Line	:
City	:	TULLY
State	:	NY
Zip	:	13159-3218
Country	:	US
Telephone Number	:	607-423-4831
Fax Number	:

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

Provider Enumeration Date	:	09/28/2022
Last Update Date	:	09/28/2022

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