Provider Demographics
NPI:1669401634
Name:BARDY, CHRISTINE E (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:E
Last Name:BARDY
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 1:621 CAPE CORAL PKWY E STE 16
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-8590
Mailing Address - Country:US
Mailing Address - Phone:239-699-7328
Mailing Address - Fax:
Practice Address - Street 1:621 CAPE CORAL PKWY E STE 16
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-8590
Practice Address - Country:US
Practice Address - Phone:239-699-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
379864OtherUNITED BEHAVIORAL HEALTH
NYP3541318OtherOXFORD HEALTH PLANS
NY172193OtherEMPIRE NYSHIP
NY267642OtherMHN
7881740OtherAETNA
VL3232OtherEMPIREBLUE
NY6894405OtherGHI
7881740OtherAETNA
NY172193OtherEMPIRE NYSHIP