Provider Demographics
NPI:1164821211
Name:GANGADYAL, JOANNA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GANGADYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:CARDACCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:227 E JIMMIE LEEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9548
Mailing Address - Country:US
Mailing Address - Phone:609-708-8992
Mailing Address - Fax:609-748-8991
Practice Address - Street 1:227 E JIMMIE LEEDS RD
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9548
Practice Address - Country:US
Practice Address - Phone:609-748-8992
Practice Address - Fax:609-748-8991
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00454300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional