Healthcare Provider Details

I. General information

NPI: 1063701910
Provider Name (Legal Business Name): KENIA ARTIS MSW, CADC, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENIA VIDAL MSW, CADC, CASAC

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 COOPER LANDING RD
CHERRY HILL NJ
08002-2504
US

IV. Provider business mailing address

19 E ORMOND AVE
CHERRY HILL NJ
08034-2053
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-4357
  • Fax: 856-665-5193
Mailing address:
  • Phone: 856-428-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37CA00071000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17340
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: