Provider Demographics
NPI:1336420264
Name:MADRIGAL, GERARDO LEOPOLDO (LMFT)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:LEOPOLDO
Last Name:MADRIGAL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 N PALM AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-1947
Mailing Address - Country:US
Mailing Address - Phone:559-367-9734
Mailing Address - Fax:
Practice Address - Street 1:2045 E ASHLAN AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-2000
Practice Address - Country:US
Practice Address - Phone:559-367-9734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101044Medicaid