MEDICARE: NICHOLAS GIARDINO PHD PSYCHOLOGY PC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1700748308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS GIARDINO PHD PSYCHOLOGY PC

Provider Business Mailing Address
First Line	:	625 DUFRANC AVE
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-3342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 PETALUMA AVE STE 2B
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4234
Country	:	US
Telephone Number	:	707-360-2090
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	NICHOLAS GIARDINO
Credential	:	PHD
Telephone Number	:	734-330-1069

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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