MEDICARE: MIRIAM CARDONA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730882838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM CARDONA LCSW

Provider Business Mailing Address
First Line	:	707 EL PASO ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-3307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 N SAINT PAUL ST STE 25045790
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-3236
Country	:	US
Telephone Number	:	508-202-1011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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Directions to “ MIRIAM CARDONA LCSW” Practice Location

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