Provider Demographics
NPI:1013130806
Name:GIOVANNOLI, RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GIOVANNOLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 GRAVENSTEIN HIGHWAY SOUTH
Mailing Address - Street 2:SUITE 12
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-5603
Mailing Address - Country:US
Mailing Address - Phone:707-824-8834
Mailing Address - Fax:707-922-0294
Practice Address - Street 1:874 GRAVENSTEIN HIGHWAY SOUTH
Practice Address - Street 2:SUITE 12
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-5603
Practice Address - Country:US
Practice Address - Phone:707-824-8834
Practice Address - Fax:707-922-0294
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22314103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling