MEDICARE: MRS. CAROL L. GIANELO LCSW

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	1041C0700X	Clinical Social Worker	370522-3502	UT

General Provider Information

NPI Number	:	1154382000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL L. GIANELO LCSW

Provider Business Mailing Address
First Line	:	81 SOUTH SKYCREST LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1604
Country	:	US
Telephone Number	:	801-205-4890
Fax Number	:	801-521-0311

Provider Business Practice Location Address
First Line	:	1355 S 1100 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2432
Country	:	US
Telephone Number	:	801-205-4890
Fax Number	:	801-521-0311

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	06/07/2011

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