Healthcare Provider Details

I. General information

NPI: 1548191844
Provider Name (Legal Business Name): ANA V CARDOSO TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 BANGOR RD
LAWRENCE MI
49064-9618
US

IV. Provider business mailing address

129 BANGOR RD
LAWRENCE MI
49064-9618
US

V. Phone/Fax

Practice location:
  • Phone: 269-363-3212
  • Fax:
Mailing address:
  • Phone: 269-363-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6362010368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: