Provider Demographics
NPI:1386454593
Name:MADRIGAL, GIOVANNA PEREZ (MFT-A)
Entity type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:PEREZ
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:GIOVANNA RALENDA
Other - Middle Name:ACEVEDO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40594
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1594
Mailing Address - Country:US
Mailing Address - Phone:210-326-2593
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 40594
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-1594
Practice Address - Country:US
Practice Address - Phone:210-326-2593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist