Healthcare Provider Details

I. General information

NPI: 1225037278
Provider Name (Legal Business Name): MARY JO HARDICK LCSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WALNUT BOTTOM RD STONER BUILDING, SUITE 311
CARLISLE PA
17015-7766
US

IV. Provider business mailing address

1200 WALNUT BOTTOM RD STONER BUILDING, SUITE 311
CARLISLE PA
17015-7766
US

V. Phone/Fax

Practice location:
  • Phone: 717-243-1511
  • Fax: 717-243-1530
Mailing address:
  • Phone: 717-243-1511
  • Fax: 717-243-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-003973-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF-0000-88
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: