Provider Demographics
NPI:1255640132
Name:KARDARAS, NICHOLAS (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KARDARAS
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PEQUASH AVE
Mailing Address - Street 2:PO BOX 226
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935-1447
Mailing Address - Country:US
Mailing Address - Phone:347-528-8108
Mailing Address - Fax:
Practice Address - Street 1:53480 MAIN ROAD ROUTE 25
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971
Practice Address - Country:US
Practice Address - Phone:347-528-8108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0726491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical