Provider Demographics
NPI:1790241545
Name:CANTU, GERARDO RAFAEL (LMSW)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:RAFAEL
Last Name:CANTU
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 AUTUMN RIDGE DR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-3227
Mailing Address - Country:US
Mailing Address - Phone:251-648-3017
Mailing Address - Fax:
Practice Address - Street 1:3116 AUTUMN RIDGE DR W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3227
Practice Address - Country:US
Practice Address - Phone:251-648-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4134G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4134GOtherTHE ALABAMA STATE BOARD OF SOCIAL WORK EXAMINERS