Provider Demographics
NPI:1538494976
Name:CARDENAS, ED (MSW, LISW, CAC)
Entity Type:Individual
Prefix:MR
First Name:ED
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:MSW, LISW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 74 BOX 22025
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-9544
Mailing Address - Country:US
Mailing Address - Phone:575-751-7486
Mailing Address - Fax:575-751-7486
Practice Address - Street 1:HC 74 BOX 22025
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-9544
Practice Address - Country:US
Practice Address - Phone:575-751-7486
Practice Address - Fax:575-751-7486
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-0873104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker