MEDICARE: DR. GRACIELA MONICA GARIBALDI PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS15506	CA

General Provider Information

NPI Number	:	1861525594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRACIELA MONICA GARIBALDI PSYD

Provider Business Mailing Address
First Line	:	370 CRENSHAW BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-1727
Country	:	US
Telephone Number	:	310-968-1949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 PACIFIC COAST HWY
Second Line	:	SUITE 304A
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-2757
Country	:	US
Telephone Number	:	310-968-1949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/09/2010

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