Provider Demographics
NPI:1326551383
Name:GIARDINI, CAROLYN (QASP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GIARDINI
Suffix:
Gender:F
Credentials:QASP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:RAYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QASP
Mailing Address - Street 1:2080 N TUSTIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7875
Mailing Address - Country:US
Mailing Address - Phone:855-581-0100
Mailing Address - Fax:855-329-3973
Practice Address - Street 1:2080 N TUSTIN AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7875
Practice Address - Country:US
Practice Address - Phone:855-581-0100
Practice Address - Fax:855-329-3973
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8664106S00000X
1-20-41960103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician