Provider Demographics
NPI:1669543898
Name:GIORDANO, ANTHONY L (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:GIORDANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHURCH RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1454
Mailing Address - Country:US
Mailing Address - Phone:856-755-1313
Mailing Address - Fax:856-755-1339
Practice Address - Street 1:1050 KINGS HWY N
Practice Address - Street 2:SUITE 103
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1909
Practice Address - Country:US
Practice Address - Phone:856-755-1313
Practice Address - Fax:856-755-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00342800103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7805501Medicaid
NJ7805501Medicaid