Provider Demographics
NPI:1962754515
Name:ARDOLINO, DEBORAH SIRY (LPC LMFT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SIRY
Last Name:ARDOLINO
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18685 MAIN ST
Mailing Address - Street 2:SUITE 101-348
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18685 MAIN ST
Practice Address - Street 2:SUITE 101-348
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1723
Practice Address - Country:US
Practice Address - Phone:310-874-4365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12889101YP2500X
CAMFC 41978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist