Healthcare Provider Details

I. General information

NPI: 1861726663
Provider Name (Legal Business Name): MARY ELIZABETH CARDONI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEG ELIZABETH CARDONI PHD

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 SOUTH YALE AVENUE SUITE 103
TULSA OK
74135
US

IV. Provider business mailing address

5110 SOUTH YALE AVENUE SUITE 103
TULSA OK
74135
US

V. Phone/Fax

Practice location:
  • Phone: 918-779-7637
  • Fax: 918-938-6037
Mailing address:
  • Phone: 918-779-7637
  • Fax: 918-938-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: