Provider Demographics
NPI:1194835843
Name:JEAN-LOUIS, GIRARDIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GIRARDIN
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3839 FLATLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3500
Mailing Address - Country:US
Mailing Address - Phone:718-252-1117
Mailing Address - Fax:718-252-4185
Practice Address - Street 1:3839 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3500
Practice Address - Country:US
Practice Address - Phone:718-252-1117
Practice Address - Fax:718-252-4185
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYQ17050103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02571108Medicaid
NY02571108Medicaid
NYVM4361Medicare ID - Type Unspecified