Provider Demographics
NPI:1598316754
Name:CARDONA, EDIELYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EDIELYNN
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4206
Mailing Address - Country:US
Mailing Address - Phone:860-229-4830
Mailing Address - Fax:
Practice Address - Street 1:233 MAIN ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4206
Practice Address - Country:US
Practice Address - Phone:860-229-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional