Provider Demographics
NPI:1518976265
Name:CARDWELL, EVERETT R (PSY D)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:R
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WICKES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1161
Mailing Address - Country:US
Mailing Address - Phone:210-223-6483
Mailing Address - Fax:
Practice Address - Street 1:102 WICKES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1161
Practice Address - Country:US
Practice Address - Phone:210-223-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G4263Medicare ID - Type UnspecifiedDOCS TX 00143K
TX8G4262Medicare ID - Type UnspecifiedDOMHA TX 00R03T