Provider Demographics
NPI:1639183346
Name:KARDOS, MARY PATRICIA (MA, CACIII)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:KARDOS
Suffix:
Gender:F
Credentials:MA, CACIII
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PATRICIA
Other - Last Name:WYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:26165 STANSBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9178
Mailing Address - Country:US
Mailing Address - Phone:303-809-2864
Mailing Address - Fax:
Practice Address - Street 1:4141 E DICKENSON PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6012
Practice Address - Country:US
Practice Address - Phone:303-504-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6300101YA0400X
CO5048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)