Provider Demographics
NPI:1164826947
Name:KARDONSKY, ERICA (LCSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KARDONSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12061 TIVOLI PARK ROW UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4383
Mailing Address - Country:US
Mailing Address - Phone:805-234-5714
Mailing Address - Fax:
Practice Address - Street 1:9815 CARROLL CANYON RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1123
Practice Address - Country:US
Practice Address - Phone:805-234-5714
Practice Address - Fax:858-408-7141
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760631041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical