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General NPI Number Information
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NPI Number | 1831309814
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Entity Type | Individual
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Provider Name | BARRY ROBERT ARDOLF PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD PSYCHOLOGY SERVICE (116B)
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 S LANCASTER RD PSYCHOLOGY SERVICE (116B)
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-0530
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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 | 6301013048
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301013048
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License Number State | MI
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