Provider Demographics
NPI:1306858147
Name:GIORDANO, ARLENE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:S
Last Name:GIORDANO
Suffix:
Gender:F
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:P O BOX 154
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-0154
Mailing Address - Country:US
Mailing Address - Phone:209-533-2137
Mailing Address - Fax:209-532-3929
Practice Address - Street 1:101 S FOREST RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4895
Practice Address - Country:US
Practice Address - Phone:209-533-2137
Practice Address - Fax:209-532-3929
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9078103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL90780Medicare PIN