MEDICARE: MARY GIANATASIO

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851699706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GIANATASIO

Provider Business Mailing Address
First Line	:	5401 BENDING OAKS PL
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-4456
Country	:	US
Telephone Number	:	630-404-7834
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 N DAMEN AVE
Second Line	:	2F
City	:	CHICAGO
State	:	IL
Zip	:	60647-3359
Country	:	US
Telephone Number	:	773-255-1855
Fax Number	:

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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