Provider Demographics
NPI:1669670949
Name:CARDWELL, REBECCA LEE (MA, MFT-I)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:MA, MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 FOLSOM RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2767
Mailing Address - Country:US
Mailing Address - Phone:916-783-4950
Mailing Address - Fax:916-783-4950
Practice Address - Street 1:420 FOLSOM RD STE C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2767
Practice Address - Country:US
Practice Address - Phone:916-783-4950
Practice Address - Fax:916-783-4950
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53523171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator