MEDICARE: MRS. KRISTEN MARIE GIRARDI LCSW

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	C004256	NC

General Provider Information

NPI Number	:	1760584619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN MARIE GIRARDI LCSW

Provider Business Mailing Address
First Line	:	11820 MOUNTBATTEN WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-6015
Country	:	US
Telephone Number	:	919-847-6417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 FALSTAFF RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1813
Country	:	US
Telephone Number	:	919-212-9495
Fax Number	:

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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