Provider Demographics
NPI:1083071450
Name:CARDONA, MIRIAM (LPCC)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8369 POLO TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2762
Mailing Address - Country:US
Mailing Address - Phone:513-500-7510
Mailing Address - Fax:513-755-7341
Practice Address - Street 1:8080 BECKETT CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5040
Practice Address - Country:US
Practice Address - Phone:513-500-7510
Practice Address - Fax:513-755-7341
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health