Provider Demographics
NPI:1114150042
Name:CARDONA, DEBBIE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:CARDONA
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 1:20 SWEETCAKE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-4106
Mailing Address - Country:US
Mailing Address - Phone:203-746-2564
Mailing Address - Fax:203-746-2564
Practice Address - Street 1:20 SWEETCAKE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-4106
Practice Address - Country:US
Practice Address - Phone:203-746-2564
Practice Address - Fax:203-746-2564
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070827-1104100000X
CT0093691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical