Provider Demographics
NPI:1760507156
Name:CARDONA, ISIDRO (MED,CADC,NCRS)
Entity Type:Individual
Prefix:
First Name:ISIDRO
Middle Name:
Last Name:CARDONA
Suffix:
Gender:M
Credentials:MED,CADC,NCRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 N OAKLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3507
Mailing Address - Country:US
Mailing Address - Phone:312-770-3313
Mailing Address - Fax:
Practice Address - Street 1:2230 N 77TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3014
Practice Address - Country:US
Practice Address - Phone:708-452-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17651101YA0400X
IL24499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)