MEDICARE: CAROLINE SUSY CARDENAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	105338	CA
2	1041C0700X	Clinical Social Worker	435421	CA

General Provider Information

NPI Number	:	1336815364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE SUSY CARDENAS

Provider Business Mailing Address
First Line	:	909 COLEMAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1534
Country	:	US
Telephone Number	:	408-277-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 COLEMAN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-1534
Country	:	US
Telephone Number	:	408-277-1821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	10/26/2022

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Directions to “ CAROLINE SUSY CARDENAS ” Practice Location

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