Provider Demographics
NPI:1073665790
Name:ARDO, CARMEN (LIC PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:CARMEN
Middle Name:
Last Name:ARDO
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRYDEN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3524
Mailing Address - Country:US
Mailing Address - Phone:570-655-0167
Mailing Address - Fax:570-655-0167
Practice Address - Street 1:CONFIDENTIAL COUNSELING
Practice Address - Street 2:359 SOUTH MOUNTAIN BLVD. SUITE C-2
Practice Address - City:MOUNTAINTOP
Practice Address - State:PA
Practice Address - Zip Code:18707
Practice Address - Country:US
Practice Address - Phone:570-403-5080
Practice Address - Fax:570-403-5079
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007046L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical