Provider Demographics
NPI:1235216854
Name:GIARDINO, NICHOLAS D (PHD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:GIARDINO
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 1:131 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4622
Mailing Address - Country:US
Mailing Address - Phone:774-264-8050
Mailing Address - Fax:
Practice Address - Street 1:2 CHARLES ST STE A2-4
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2269
Practice Address - Country:US
Practice Address - Phone:774-264-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013090103TC0700X
RIPS01544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ63312Medicare UPIN
MI0H16185047Medicare ID - Type Unspecified