Provider Demographics
NPI:1770108284
Name:GIOVINO, ROGER RYAN (PSYD)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:RYAN
Last Name:GIOVINO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 W PARKER RD APT 932
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8620
Mailing Address - Country:US
Mailing Address - Phone:401-526-4522
Mailing Address - Fax:
Practice Address - Street 1:14275 MIDWAY RD STE 260
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3613
Practice Address - Country:US
Practice Address - Phone:469-665-9445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent