Provider Demographics
NPI:1326761099
Name:CARDINAL, LAURA MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 M AVE STE G
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-3897
Mailing Address - Country:US
Mailing Address - Phone:360-299-4297
Mailing Address - Fax:360-299-4294
Practice Address - Street 1:2511 M AVE STE G
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-3897
Practice Address - Country:US
Practice Address - Phone:360-299-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW602060521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical