Healthcare Provider Details

I. General information

NPI: 1801413901
Provider Name (Legal Business Name): MARGOT ELIZABETH DENON-CARDARELLI SUDCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 STEELE LN
SANTA ROSA CA
95403-3127
US

IV. Provider business mailing address

625 STEELE LN
SANTA ROSA CA
95403-3127
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-0818
  • Fax: 707-576-7845
Mailing address:
  • Phone: 707-576-0818
  • Fax: 707-576-7845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number49-02
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: