Provider Demographics
NPI:1790296143
Name:CARDENAS, TAMARA (ASW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2875
Mailing Address - Country:US
Mailing Address - Phone:530-312-0627
Mailing Address - Fax:
Practice Address - Street 1:6615 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7076
Practice Address - Country:US
Practice Address - Phone:916-450-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90825104100000X
CA1160181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker