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Organization
PHILLIP TARDANICO, LICENSED CLINICAL SOCIAL WORKER & ASSOCIATES, PC
Active
Organization
PHILLIP TARDANICO, LICENSED CLINICAL SOCIAL WORKER & ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILLIP TARDANICO MSW, LCSW (PRESIDENT/CEO)
(760) 217-9527
Entity
Organization
Contact information
Practice address
15000 7TH ST STE 209, VICTORVILLE, CA 92395-3853
(760) 217-9527
(442) 267-5623
Mailing address
15000 7TH STREET SUITE 201, VICTORVILLE, CA 92395-2463
(760) 217-9527
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800682649
—
CA
Enumeration date
07/20/2020
Last updated
11/23/2021
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