Basic Information
| Provider Information | |||||||||
| NPI: | 1730859810 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIANNOTTI | ||||||||
| FirstName: | MARY FRANCES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 PERKINS ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065133209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039075979 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 54 E RAMSDELL ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065151140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033379943 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2021 | ||||||||
| LastUpdateDate: | 01/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 10039 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 008022622 | 05 | CT | MEDICAID | 004082260 | 05 | CT | MEDICAID | 008001325 | 05 | CT | MEDICAID | 008039745 | 05 | CT | MEDICAID | 008023170 | 05 | CT | MEDICAID | 008042339 | 05 | CT | MEDICAID | 008105797 | 05 | CT | MEDICAID | 008024427 | 05 | CT | MEDICAID |