Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS018815 | PA |
Y | 103TC0700X | Clinical Psychologist | PS018815 | PA |
NPI | 1003189739 |
---|---|
Provider Name | Daniel Tomas Pardo |
First Address | Weston, FL 33326-4545 |
Second Address | Lancaster, PA 17602-2137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 19/07/2019 |