Carolyn Dawn Giannone, PH.D., LP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

5627 Issued in MN

Practice address

1500 Irving St
Alexandria, MN 56308-2515

Phone

(320) 762-2400

Fax

(320) 762-8047

NPI assigned

Oct 21, 2010

Last updated

May 13, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Carolyn Dawn Tudisco Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lakeland Mental Health Center IncGroup PAC ID 1759291891, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakeland Mental Health Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fergus Falls, MN
  • NPI 1366480287
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1699085803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1914 FAIRWAY LN NE",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563088611",
            "telephone_number": "320-762-2400",
            "fax_number": "320-762-8047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 IRVING ST",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563082515",
            "telephone_number": "320-762-2400",
            "fax_number": "320-762-8047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIANNONE",
        "first_name": "CAROLYN",
        "middle_name": "DAWN",
        "credential": "PH.D., LP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-21",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "5627",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "TUDISCO",
            "middle_name": "DAWN",
            "credential": "MS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• John A Gess, OD
• Timothy L Gess, M.D.
• Alicia Gettel
• Anne G Gilbertson, CNM
• Gillette Children's Specialty Healthcare
• Brooke Girtz
• Billie K Glade, MD
• Godfrey Chiropractic Clinic Inc

• Clinical Psychologist in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.