Provider Demographics
NPI:1053553073
Name:GIRARDI, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:GIRARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COMBS AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1455
Mailing Address - Country:US
Mailing Address - Phone:516-524-3412
Mailing Address - Fax:516-605-6020
Practice Address - Street 1:165 COMBS AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1455
Practice Address - Country:US
Practice Address - Phone:516-524-3412
Practice Address - Fax:516-605-6020
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR046031-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR046031-1Medicare PIN