Active NPI
Carlo A. Giacomoni, PSYD
- Psychologist
- Little Canada, MN
National Provider Identifier
1104061902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5506
- Practice address
- 2984 Rice St
Little Canada, MN 55113-2230 - Phone
- (651) 314-4350
- NPI assigned
- Dec 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2779 | WI | |
| Psychologist | 103T00000X | 5506 | MN | Primary |
Addresses
Primary practice location
2984 Rice St
Little Canada, MN 55113-2230
Mailing address
2984 Rice St
Little Canada, MN 55113-2230
Phone (651) 314-4350
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5506 | MN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allied Mental Health Specialty Group SC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Hudson, WI
- NPI 1831315191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1228694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1509321600000",
"number": "1104061902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2984 RICE ST",
"city": "LITTLE CANADA",
"state": "MN",
"postal_code": "551132230",
"telephone_number": "651-314-4350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2984 RICE ST",
"city": "LITTLE CANADA",
"state": "MN",
"postal_code": "551132230",
"telephone_number": "651-314-4350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIACOMONI",
"first_name": "CARLO",
"middle_name": "A.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-08",
"last_updated": "2017-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2779",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "5506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Canada, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.