Provider Demographics
NPI:1538798434
Name:GIRARD, JUSTINE (LCAT, ATR-BC, SEP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:GIRARD
Suffix:
Gender:F
Credentials:LCAT, ATR-BC, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LAVETA PL
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1603
Mailing Address - Country:US
Mailing Address - Phone:845-353-1230
Mailing Address - Fax:
Practice Address - Street 1:31 LAVETA PL
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1603
Practice Address - Country:US
Practice Address - Phone:845-353-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001868221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty