Provider Demographics
NPI:1598028078
Name:CONTEGIACOMO, JOANNE MARIE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:CONTEGIACOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 CLARINBRIDGE PKWY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6658
Mailing Address - Country:US
Mailing Address - Phone:516-652-8008
Mailing Address - Fax:
Practice Address - Street 1:818 CLARINBRIDGE PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6658
Practice Address - Country:US
Practice Address - Phone:516-652-8008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174400000XOther Service ProvidersSpecialist