Provider Demographics
NPI:1568208817
Name:BARDMAN, SEMONA
Entity type:Individual
Prefix:
First Name:SEMONA
Middle Name:
Last Name:BARDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 E 26TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2403
Mailing Address - Country:US
Mailing Address - Phone:718-844-6510
Mailing Address - Fax:
Practice Address - Street 1:2463 E 26TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2403
Practice Address - Country:US
Practice Address - Phone:718-844-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool