Provider Demographics
NPI:1194959429
Name:JOHN B. CARDINALI, PSY.D., PS
Entity type:Organization
Organization Name:JOHN B. CARDINALI, PSY.D., PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARDINALI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:206-721-1200
Mailing Address - Street 1:4705 16TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4208
Mailing Address - Country:US
Mailing Address - Phone:206-721-1200
Mailing Address - Fax:206-527-0725
Practice Address - Street 1:4705 16TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4208
Practice Address - Country:US
Practice Address - Phone:206-721-1200
Practice Address - Fax:206-527-0725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY2300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty