MEDICARE: MARIO GARNELLO

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	106S00000X	Behavior Technician	G65455599144	IL

General Provider Information

NPI Number	:	1396691135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO GARNELLO

Provider Business Mailing Address
First Line	:	7N210 MEDINAH RD
Second Line	:
City	:	MEDINAH
State	:	IL
Zip	:	60157-9665
Country	:	US
Telephone Number	:	800-844-1232
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 W HAWTHORN DR
Second Line	:
City	:	ITASCA
State	:	IL
Zip	:	60143-2056
Country	:	US
Telephone Number	:	800-844-1232
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ MARIO GARNELLO ” Practice Location

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