Provider Demographics
NPI:1639525637
Name:MEDAL CARDOZA, CECILIA (LSW)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:MEDAL CARDOZA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10680 CEDAR BEND CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-8204
Mailing Address - Country:US
Mailing Address - Phone:775-200-8528
Mailing Address - Fax:775-800-1551
Practice Address - Street 1:1155 W 4TH ST STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5146
Practice Address - Country:US
Practice Address - Phone:775-200-8528
Practice Address - Fax:774-800-5115
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6047-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker