Healthcare Provider Details

I. General information

NPI: 1982958617
Provider Name (Legal Business Name): MARGARET MARY CARDENAS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 NORTH SMITH AVENUE CHILDREN'S HEALTH CARE
ST. PAUL MN
55102-2387
US

IV. Provider business mailing address

205 MORTON ST E
SAINT PAUL MN
55107-3073
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6479
  • Fax: 651-220-6393
Mailing address:
  • Phone: 651-330-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3666
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: