Provider Demographics
NPI:1023592573
Name:CHARDON, ARIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:
Last Name:CHARDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 CALLE RENIFORME
Mailing Address - Street 2:JARDINES DEL CARIBE 5TA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:939-282-2269
Mailing Address - Fax:
Practice Address - Street 1:5145 CALLE RENIFORME
Practice Address - Street 2:JARDINES DEL CARIBE 5TA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3522
Practice Address - Country:US
Practice Address - Phone:939-282-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1265103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling