Healthcare Provider Details

I. General information

NPI: 1093624033
Provider Name (Legal Business Name): ESTEBAN CARDEMIL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAIN ST
WORCESTER MA
01610-1400
US

IV. Provider business mailing address

950 MAIN ST
WORCESTER MA
01610-1400
US

V. Phone/Fax

Practice location:
  • Phone: 401-286-6771
  • Fax:
Mailing address:
  • Phone: 401-286-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: