Provider Demographics
NPI:1225037278
Name:HARDICK, MARY JO (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY JO
Middle Name:
Last Name:HARDICK
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WALNUT BOTTOM RD
Mailing Address - Street 2:STONER BUILDING, SUITE 311
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7766
Mailing Address - Country:US
Mailing Address - Phone:717-243-1511
Mailing Address - Fax:717-243-1530
Practice Address - Street 1:1200 WALNUT BOTTOM RD
Practice Address - Street 2:STONER BUILDING, SUITE 311
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7766
Practice Address - Country:US
Practice Address - Phone:717-243-1511
Practice Address - Fax:717-243-1530
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-003973-L1041C0700X
PAMF-0000-88106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP50097Medicare UPIN
PA054712Medicare PIN