Provider Demographics
NPI:1699068619
Name:HARDAKER, MARIE NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NICOLE
Last Name:HARDAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATIENCE
Other - Middle Name:
Other - Last Name:HARDAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:593 OZONA VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683
Mailing Address - Country:US
Mailing Address - Phone:727-804-3933
Mailing Address - Fax:
Practice Address - Street 1:5404 CYPRESS CENTER DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1044
Practice Address - Country:US
Practice Address - Phone:804-904-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 7292104100000X
FLSW119531041C0700X
VA09040087991041C0700X
WYLSWW-14091041C0700X
PASW128367104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical