Provider Demographics
NPI:1093297814
Name:CARDILLO, IVY ROSE
Entity Type:Individual
Prefix:
First Name:IVY ROSE
Middle Name:
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:12514-2550
Mailing Address - Country:US
Mailing Address - Phone:845-271-9925
Mailing Address - Fax:
Practice Address - Street 1:1 N FRONT ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3813
Practice Address - Country:US
Practice Address - Phone:845-679-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical