MEDICARE: MR. THOMAS JOSEPH BARDIN III BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-17-28411	OTHER		BCBA NUMBER

General Provider Information

NPI Number	:	1922477934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOSEPH BARDIN III BCBA

Provider Business Mailing Address
First Line	:	2306 HURON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-3828
Country	:	US
Telephone Number	:	803-606-5662
Fax Number	:	803-339-1907

Provider Business Practice Location Address
First Line	:	2306 HURON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-3828
Country	:	US
Telephone Number	:	803-606-5662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2015
Last Update Date	:	06/11/2019

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