Provider Demographics
NPI:1508376112
Name:TARDIF, ALLISON (ATR-BC, LPC, CLAT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:TARDIF
Suffix:
Gender:F
Credentials:ATR-BC, LPC, CLAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BERLE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-1522
Mailing Address - Country:US
Mailing Address - Phone:860-990-8302
Mailing Address - Fax:
Practice Address - Street 1:85 FELT RD STE 602
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3871
Practice Address - Country:US
Practice Address - Phone:860-918-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012124101YP2500X
TX9084101YP2500X
CT003174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional