Provider Demographics
NPI:1326270729
Name:KARDARAS, KATHLEEN (PSYD, LCPC, MHT)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:KARDARAS
Suffix:
Gender:F
Credentials:PSYD, LCPC, MHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 N KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4031
Mailing Address - Country:US
Mailing Address - Phone:773-777-4003
Mailing Address - Fax:847-673-8802
Practice Address - Street 1:4741 N KNOX AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4031
Practice Address - Country:US
Practice Address - Phone:773-777-4003
Practice Address - Fax:847-673-8802
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional