Provider Demographics
NPI:1386155190
Name:GIRONDO, CORRINE (MS LBS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:
Last Name:GIRONDO
Suffix:
Gender:F
Credentials:MS LBS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8102
Mailing Address - Country:US
Mailing Address - Phone:570-205-0407
Mailing Address - Fax:570-205-0407
Practice Address - Street 1:5 SENTRY PKWY E STE 200
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2307
Practice Address - Country:US
Practice Address - Phone:267-465-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB228209103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst