Healthcare Provider Details

I. General information

NPI: 1255104634
Provider Name (Legal Business Name): HIRALDO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MAIN ST
COVINGTON KY
41011-1331
US

IV. Provider business mailing address

777 HIGHLAND AVE
FT WRIGHT KY
41011-4064
US

V. Phone/Fax

Practice location:
  • Phone: 859-363-6131
  • Fax:
Mailing address:
  • Phone: 918-625-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RACHEL HIRALDO
Title or Position: OWNER
Credential: LPCC
Phone: 859-363-6131