Provider Demographics
NPI:1811338056
Name:GIARDINA, ANTHONY NELLO (PSY D)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:NELLO
Last Name:GIARDINA
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 NE HALSEY ST
Mailing Address - Street 2:APT 4
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1562
Mailing Address - Country:US
Mailing Address - Phone:254-258-0723
Mailing Address - Fax:
Practice Address - Street 1:2138 NE HALSEY ST
Practice Address - Street 2:APT 4
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1562
Practice Address - Country:US
Practice Address - Phone:254-258-0723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)