Provider Demographics
NPI:1336972702
Name:BASILIO, GIOVANNA (PSYD)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:BASILIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 N UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4640
Mailing Address - Country:US
Mailing Address - Phone:954-803-9002
Mailing Address - Fax:954-933-2305
Practice Address - Street 1:5441 N UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4640
Practice Address - Country:US
Practice Address - Phone:954-803-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12341103TC0700X
103TF0200X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic