Provider Demographics
NPI:1780986414
Name:ANDERSON, CHERYL TARDOSKY (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:TARDOSKY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3063 SW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7934
Mailing Address - Country:US
Mailing Address - Phone:352-333-7239
Mailing Address - Fax:
Practice Address - Street 1:3063 SW 92ND ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7934
Practice Address - Country:US
Practice Address - Phone:352-333-7239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL#Z6508OtherBLUE CROSS/BLUE SHIELD PROVIDER NUMBER