Provider Demographics
NPI:1154830925
Name:STAFFARONI, GISELLE
Entity Type:Individual
Prefix:MRS
First Name:GISELLE
Middle Name:
Last Name:STAFFARONI
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 1:909 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1603
Mailing Address - Country:US
Mailing Address - Phone:610-433-7689
Mailing Address - Fax:
Practice Address - Street 1:425 DIVISADERO ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2242
Practice Address - Country:US
Practice Address - Phone:415-551-0975
Practice Address - Fax:415-551-0975
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 225X00000X
CA18435225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor