Provider Demographics
NPI:1679114003
Name:CRAIG CARDAMONE INDIVIDUAL AND RELATIONAL THERAPY PLLC
Entity type:Organization
Organization Name:CRAIG CARDAMONE INDIVIDUAL AND RELATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMFT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDAMONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:281-796-8860
Mailing Address - Street 1:12 KELLOGG ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4375
Mailing Address - Country:US
Mailing Address - Phone:281-796-8860
Mailing Address - Fax:
Practice Address - Street 1:12 KELLOGG ST APT 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4375
Practice Address - Country:US
Practice Address - Phone:281-796-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty