Provider Demographics
NPI:1922177518
Name:DE NARDIS, MARIA COLETTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:COLETTE
Last Name:DE NARDIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6797 N HIGH ST STE 306
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2588
Mailing Address - Country:US
Mailing Address - Phone:614-309-1215
Mailing Address - Fax:614-262-0963
Practice Address - Street 1:6797 N HIGH ST STE 306
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2588
Practice Address - Country:US
Practice Address - Phone:614-309-1215
Practice Address - Fax:614-262-0963
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDECP22711Medicare ID - Type Unspecified