Healthcare Provider Details

I. General information

NPI: 1255251476
Provider Name (Legal Business Name): GRACIE GARIBALDI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SUNRISE AVE ST D212
ROSEVILLE CA
95661-4516
US

IV. Provider business mailing address

2409 GLENFAIRE DR
RANCHO CORDOVA CA
95670-3921
US

V. Phone/Fax

Practice location:
  • Phone: 530-264-8804
  • Fax:
Mailing address:
  • Phone: 916-878-7152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: