Provider Demographics
NPI:1407269608
Name:MINARDI, GINA MARIE (MFT)
Entity Type:Individual
Prefix:MISS
First Name:GINA
Middle Name:MARIE
Last Name:MINARDI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12452 SHORT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6441
Mailing Address - Country:US
Mailing Address - Phone:831-206-0345
Mailing Address - Fax:
Practice Address - Street 1:12452 SHORT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6441
Practice Address - Country:US
Practice Address - Phone:831-206-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT93740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist