Provider Demographics
NPI:1174676233
Name:ABBONDANDOLO, ANTHONY JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:ABBONDANDOLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SAINT PAUL ST
Mailing Address - Street 2:406
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2619
Mailing Address - Country:US
Mailing Address - Phone:410-528-1642
Mailing Address - Fax:410-528-1642
Practice Address - Street 1:1101 SAINT PAUL ST
Practice Address - Street 2:406
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2619
Practice Address - Country:US
Practice Address - Phone:410-528-1642
Practice Address - Fax:410-528-1642
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1920103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist