Healthcare Provider Details

I. General information

NPI: 1205177342
Provider Name (Legal Business Name): MEGAN MARDO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SHARON DR
CUMBERLAND RI
02864-6109
US

IV. Provider business mailing address

9 SHARON DR
CUMBERLAND RI
02864-6109
US

V. Phone/Fax

Practice location:
  • Phone: 908-910-3561
  • Fax:
Mailing address:
  • Phone: 908-910-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00740
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005742
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: