Provider Demographics
NPI:1922477934
Name:BARDIN, THOMAS JOSEPH III (BCBA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:BARDIN
Suffix:III
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2306 HURON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3828
Mailing Address - Country:US
Mailing Address - Phone:803-606-5662
Mailing Address - Fax:803-339-1907
Practice Address - Street 1:2306 HURON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3828
Practice Address - Country:US
Practice Address - Phone:803-606-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-28411OtherBCBA NUMBER