Provider Demographics
NPI:1497100556
Name:STANDORA, JOAN (PHD, LADC, CADC)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:STANDORA
Suffix:
Gender:F
Credentials:PHD, LADC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BROAD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1366
Mailing Address - Country:US
Mailing Address - Phone:570-775-1991
Mailing Address - Fax:718-368-6544
Practice Address - Street 1:224 BROAD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1366
Practice Address - Country:US
Practice Address - Phone:570-775-1991
Practice Address - Fax:718-368-6544
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000359101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)