Individual
DR. MARIO PETER GIACOMUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD PC
Contact information
Practice address
121 S WILKE RD, SUITE 410, ARLINGTON HEIGHTS, IL 60005-1533
(847) 334-1476
(847) 429-1890
Mailing address
PO BOX 82, GILBERTS, IL 60136-0082
(847) 334-1476
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31623056
BLUE CROSS PROVIDER NUMBE
IL
Enumeration date
05/15/2007
Last updated
07/08/2007
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