Provider Demographics
NPI:1053080648
Name:GIRARDO, PERLA (PC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:PERLA
Middle Name:
Last Name:GIRARDO
Suffix:
Gender:F
Credentials:PC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4206
Mailing Address - Country:US
Mailing Address - Phone:860-224-8192
Mailing Address - Fax:
Practice Address - Street 1:233 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4206
Practice Address - Country:US
Practice Address - Phone:860-221-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional