Provider Demographics
NPI:1396840336
Name:KANTARAKIS, NORMA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:
Last Name:KANTARAKIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1322 E SHAW AVE STE 345
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7904
Mailing Address - Country:US
Mailing Address - Phone:559-960-2539
Mailing Address - Fax:
Practice Address - Street 1:1322 E SHAW AVE STE 345
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-960-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02178ZMedicare UPIN