Provider Demographics
NPI:1578906822
Name:GIRALDO, FABIOLA (MA)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:
Other - Last Name:GIRALDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1452 AVE ASHFORD
Mailing Address - Street 2:STE 411
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1581
Mailing Address - Country:US
Mailing Address - Phone:787-368-0850
Mailing Address - Fax:
Practice Address - Street 1:1452 AVE ASHFORD
Practice Address - Street 2:STE 411
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1581
Practice Address - Country:US
Practice Address - Phone:787-368-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling