Provider Demographics
NPI:1366421240
Name:CARDONA, MYRIAM MARIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:MARIA
Last Name:CARDONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1369
Mailing Address - Country:US
Mailing Address - Phone:860-223-2400
Mailing Address - Fax:860-223-2400
Practice Address - Street 1:21 GRAND STREET
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-550-7500
Practice Address - Fax:860-550-7501
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00415746900OtherANTHEM FAMILY ID
CT003406OtherSTATE LICENSE