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General NPI Number Information
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NPI Number | 1245015411
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Entity Type | Individual
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Provider Name | ALTHEA BARDIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 27005 76TH AVE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 718-470-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 600 PINE HOLLOW RD APT 7-8B
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City | EAST NORWICH
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State | NY
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Zip | 11732-1025
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Country | US
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Telephone | 646-256-7746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022840
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License Number State | NY
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