Provider Demographics
NPI:1275999229
Name:ARDO, ALYSIA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:ANN
Last Name:ARDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-2026
Mailing Address - Country:US
Mailing Address - Phone:570-881-9837
Mailing Address - Fax:
Practice Address - Street 1:1801 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1365
Practice Address - Country:US
Practice Address - Phone:570-447-1052
Practice Address - Fax:570-961-9964
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1326041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical