Healthcare Provider Details

I. General information

NPI: 1356419238
Provider Name (Legal Business Name): SHERRY CARDINAL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 HORSESHOE DR
NEEDVILLE TX
77461-8818
US

IV. Provider business mailing address

PO BOX 1395
RICHMOND TX
77406-1395
US

V. Phone/Fax

Practice location:
  • Phone: 713-594-0859
  • Fax:
Mailing address:
  • Phone: 713-594-0859
  • Fax: 281-342-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12572
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: