Provider Demographics
NPI:1073022414
Name:ANDREWS-CARDOZA, KYM M
Entity Type:Individual
Prefix:
First Name:KYM
Middle Name:M
Last Name:ANDREWS-CARDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1562
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-1562
Mailing Address - Country:US
Mailing Address - Phone:530-748-5328
Mailing Address - Fax:
Practice Address - Street 1:3057 BRIW RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5330
Practice Address - Country:US
Practice Address - Phone:530-748-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1194931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical