Provider Demographics
NPI:1497831135
Name:CARDENAS, FABIOLA (LCSW C)
Entity Type:Individual
Prefix:MRS
First Name:FABIOLA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:LCSW C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 RIDGLAND ROAD
Mailing Address - Street 2:STE 1
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-628-6120
Mailing Address - Fax:410-628-9825
Practice Address - Street 1:10400 RIDGLAND ROAD
Practice Address - Street 2:STE 1
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-628-6120
Practice Address - Fax:410-628-9825
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
182965OtherCOMPSYCH
R5830002OtherCAREFIRST GHMSI
60875901OtherCAREFIRST MD
0986C397Medicare ID - Type Unspecified