MEDICARE: MR. LUKE GIANNINI 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	0904011311	VA

General Provider Information

NPI Number	:	1396387858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LUKE GIANNINI LCSW

Provider Business Mailing Address
First Line	:	5700 W GRACE ST STE 105A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1834
Country	:	US
Telephone Number	:	804-442-3116
Fax Number	:	804-523-4958

Provider Business Practice Location Address
First Line	:	5700 W GRACE ST STE 105A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1834
Country	:	US
Telephone Number	:	804-442-3116
Fax Number	:	804-523-4958

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	11/30/2020

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