Healthcare Provider Details

I. General information

NPI: 1811338056
Provider Name (Legal Business Name): ANTHONY NELLO GIARDINA PSY D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 NE HALSEY ST APT 4
PORTLAND OR
97232-1562
US

IV. Provider business mailing address

2138 NE HALSEY ST APT 4
PORTLAND OR
97232-1562
US

V. Phone/Fax

Practice location:
  • Phone: 254-258-0723
  • Fax:
Mailing address:
  • Phone: 254-258-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: