Provider Demographics
NPI:1750423109
Name:BARDAR, NADINE M (PCC)
Entity type:Individual
Prefix:MS
First Name:NADINE
Middle Name:M
Last Name:BARDAR
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10962 GORE ORPHANAGE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-9632
Mailing Address - Country:US
Mailing Address - Phone:440-965-7670
Mailing Address - Fax:
Practice Address - Street 1:23792 LORAIN RD STE 100
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2225
Practice Address - Country:US
Practice Address - Phone:440-734-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0008270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0308483Medicaid