Provider Demographics
NPI:1386883106
Name:GIRARD, EMMA (PSYD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:GIRARD
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 1:6529 RIVERSIDE AVE
Mailing Address - Street 2:SUITE 133
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3122
Mailing Address - Country:US
Mailing Address - Phone:951-684-2627
Mailing Address - Fax:951-788-5837
Practice Address - Street 1:6529 RIVERSIDE AVE
Practice Address - Street 2:SUITE 133
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3122
Practice Address - Country:US
Practice Address - Phone:951-684-2627
Practice Address - Fax:951-788-5837
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19090103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist