Provider Demographics
NPI:1942353271
Name:CARDINALI, JOHN B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:CARDINALI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4208
Mailing Address - Country:US
Mailing Address - Phone:206-721-1200
Mailing Address - Fax:206-527-0725
Practice Address - Street 1:4705 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4208
Practice Address - Country:US
Practice Address - Phone:206-721-1200
Practice Address - Fax:206-527-0725
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical