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General NPI Number Information
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NPI Number | 1366544991
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Entity Type | Individual
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Provider Name | MARK JAMES CARDILLO LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1232 N PINELLAS AVE
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City | TARPON SPRINGS
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State | FL
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Zip | 34689
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Country | US
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Telephone | 727-944-5171
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Fax | 722-944-5174
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Provider Business Mailing Address
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Address Line | 433 4TH ST NORTH
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City | ST PETERSBURG
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State | FL
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Zip | 33701
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Country | US
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Telephone | 727-895-8499
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Fax | 727-895-8497
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW4722
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License Number State | FL
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