Provider Demographics
NPI:1205290806
Name:CARDONA, LAURA A (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:CARDONA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 CEBO CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5202
Mailing Address - Country:US
Mailing Address - Phone:940-453-7950
Mailing Address - Fax:512-717-0243
Practice Address - Street 1:3407 W SLAUGHTER LN
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5714
Practice Address - Country:US
Practice Address - Phone:512-522-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37089103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist