Provider Demographics
NPI:1265525570
Name:CARDILLO, JOSEPH PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PETER
Last Name:CARDILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:P
Other - Last Name:CARDILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 30293
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-0293
Mailing Address - Country:US
Mailing Address - Phone:505-255-7016
Mailing Address - Fax:505-294-1038
Practice Address - Street 1:1420 CARLISLE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5661
Practice Address - Country:US
Practice Address - Phone:505-255-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10405Medicaid