Provider Demographics
NPI:1750826954
Name:CARDWELL, KATHY (LCSW, LMFT, LCAC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:LCSW, LMFT, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3836
Mailing Address - Country:US
Mailing Address - Phone:317-979-4882
Mailing Address - Fax:
Practice Address - Street 1:5110 E 70TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3836
Practice Address - Country:US
Practice Address - Phone:317-979-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-23
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001330A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical