Provider Demographics
NPI:1346513702
Name:NARDI, KRIS (LSW)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:NARDI
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 TWIN STACKS DR
Mailing Address - Street 2:PO BOX 427
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-8505
Mailing Address - Country:US
Mailing Address - Phone:570-674-1505
Mailing Address - Fax:570-674-8679
Practice Address - Street 1:1172 TWIN STACKS DR
Practice Address - Street 2:SUITE BOX 427
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-8505
Practice Address - Country:US
Practice Address - Phone:570-674-1505
Practice Address - Fax:570-674-8679
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128501104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker