Healthcare Provider Details

I. General information

NPI: 1174290092
Provider Name (Legal Business Name): DORA MARIA CANTU LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W ALLUVIAL AVE STE 108
FRESNO CA
93711-5857
US

IV. Provider business mailing address

4324 W HARVARD AVE
FRESNO CA
93722-5183
US

V. Phone/Fax

Practice location:
  • Phone: 559-795-5990
  • Fax:
Mailing address:
  • Phone: 559-613-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98360
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number98360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: