Healthcare Provider Details

I. General information

NPI: 1588894521
Provider Name (Legal Business Name): ANTIONETTE CARDENAS DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3778 W 70TH PL
MERRILLVILLE IN
46410-3390
US

IV. Provider business mailing address

3778 W 70TH PL
MERRILLVILLE IN
46410-3390
US

V. Phone/Fax

Practice location:
  • Phone: 219-718-7506
  • Fax: 219-500-2932
Mailing address:
  • Phone: 219-718-7506
  • Fax: 219-500-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027831
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: