Provider Demographics
NPI:1538530076
Name:GARIBALDI, WILLIAM VAINARD IV
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:VAINARD
Last Name:GARIBALDI
Suffix:IV
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:VAINARD
Other - Last Name:GARIBALDI
Other - Suffix:IV
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:159 MOONRAKER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458
Mailing Address - Country:US
Mailing Address - Phone:985-265-7185
Mailing Address - Fax:
Practice Address - Street 1:159 MOONRAKER DRIVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458
Practice Address - Country:US
Practice Address - Phone:985-265-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2017-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120011041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical