Provider Demographics
NPI:1912911926
Name:GARIBALDI, DENISE A (PHD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:A
Last Name:GARIBALDI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2330
Mailing Address - Country:US
Mailing Address - Phone:707-769-9407
Mailing Address - Fax:707-762-1892
Practice Address - Street 1:111 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2330
Practice Address - Country:US
Practice Address - Phone:707-769-9407
Practice Address - Fax:707-762-1892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14742103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL147420Medicare ID - Type Unspecified