Provider Demographics
NPI:1568742724
Name:CANO, KINGA (MSW, QMHP)
Entity Type:Individual
Prefix:
First Name:KINGA
Middle Name:
Last Name:CANO
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:KINGA
Other - Middle Name:
Other - Last Name:BALDERAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1688
Mailing Address - Country:US
Mailing Address - Phone:630-352-7267
Mailing Address - Fax:779-234-6513
Practice Address - Street 1:40 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COAL CITY
Practice Address - State:IL
Practice Address - Zip Code:60416-1688
Practice Address - Country:US
Practice Address - Phone:630-352-7267
Practice Address - Fax:779-234-6513
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker