Provider Demographics
NPI:1194832501
Name:GIRONDA, MARC ANTONY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTONY
Last Name:GIRONDA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 KNICKERBOCKER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4823
Mailing Address - Country:US
Mailing Address - Phone:973-537-9279
Mailing Address - Fax:
Practice Address - Street 1:513 W MOUNT PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1710
Practice Address - Country:US
Practice Address - Phone:973-533-1195
Practice Address - Fax:973-533-1305
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00416100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist