Provider Demographics
NPI:1356915425
Name:CARDENAS FERNANDEZ, JORGE (CBHCM)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:CARDENAS FERNANDEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 SW 130TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4103
Mailing Address - Country:US
Mailing Address - Phone:305-964-5381
Mailing Address - Fax:
Practice Address - Street 1:13335 SW 124TH ST STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7513
Practice Address - Country:US
Practice Address - Phone:305-964-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker