Provider Demographics
NPI:1861669673
Name:GIRON, BERTHA JANINA (MA)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:JANINA
Last Name:GIRON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 W BROWARD BLVD, 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312
Mailing Address - Country:US
Mailing Address - Phone:954-707-7862
Mailing Address - Fax:
Practice Address - Street 1:3521 W BROWARD BLVD FL 3
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1048
Practice Address - Country:US
Practice Address - Phone:954-707-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLIED FORMedicaid