Provider Demographics
NPI:1861726663
Name:CARDONI, MARY ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:CARDONI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MEG
Other - Middle Name:ELIZABETH
Other - Last Name:CARDONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5110 SOUTH YALE AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-779-7637
Mailing Address - Fax:918-938-6037
Practice Address - Street 1:5110 SOUTH YALE AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-779-7637
Practice Address - Fax:918-938-6037
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist