Provider Demographics
NPI:1861982357
Name:PARDEE, CAROLYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:PARDEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:SPEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:15 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1942
Mailing Address - Country:US
Mailing Address - Phone:716-352-3889
Mailing Address - Fax:
Practice Address - Street 1:1109 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1660
Practice Address - Country:US
Practice Address - Phone:716-427-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical