Provider Demographics
NPI:1427372549
Name:GIARDINA, CARMELA J (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:J
Last Name:GIARDINA
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:J
Other - Last Name:GIARDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 WILSHIRE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1919
Mailing Address - Country:US
Mailing Address - Phone:213-416-1164
Mailing Address - Fax:213-481-7147
Practice Address - Street 1:1200 WILSHIRE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1919
Practice Address - Country:US
Practice Address - Phone:213-416-1164
Practice Address - Fax:213-481-7147
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF61721101YM0800X
CAIMF 61721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health