MEDICARE: MS. MARIA GRAZIA DI GIORGIO MA, LPC

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	LPC 4102	CO

General Provider Information

NPI Number	:	1922252402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA GRAZIA DI GIORGIO MA, LPC

Provider Business Mailing Address
First Line	:	3065 30TH ST
Second Line	:	#2B
City	:	BOULDER
State	:	CO
Zip	:	80301-1351
Country	:	US
Telephone Number	:	303-544-0889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2769 IRIS AVE
Second Line	:	SUITE #103
City	:	BOULDER
State	:	CO
Zip	:	80304-4405
Country	:	US
Telephone Number	:	303-544-0889
Fax Number	:

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

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	11/10/2008

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