Provider Demographics
NPI:1750891248
Name:MARIA ELANA CARDILLO, LLC
Entity type:Organization
Organization Name:MARIA ELANA CARDILLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA ELANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-617-3552
Mailing Address - Street 1:PO BOX 8739
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-8739
Mailing Address - Country:US
Mailing Address - Phone:856-617-3552
Mailing Address - Fax:
Practice Address - Street 1:5 CAMELOT PL LOT OFFICE
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2308
Practice Address - Country:US
Practice Address - Phone:856-981-5045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health