Provider Demographics
NPI:1497161061
Name:CARDAMONE, CRAIG (LMFT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CARDAMONE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KELLOGG ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4375
Mailing Address - Country:US
Mailing Address - Phone:207-614-7788
Mailing Address - Fax:207-569-6645
Practice Address - Street 1:142 HIGH ST STE 325
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-614-7788
Practice Address - Fax:207-569-6645
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001228-1106H00000X
MEMF5110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid