Provider Demographics
NPI:1790479327
Name:CANTWELL, KAELI EVELYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAELI
Middle Name:EVELYN
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E ROUND GROVE RD APT 1431
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8331
Mailing Address - Country:US
Mailing Address - Phone:972-746-5009
Mailing Address - Fax:
Practice Address - Street 1:1901 CENTRAL DR STE 160
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5823
Practice Address - Country:US
Practice Address - Phone:682-289-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX636371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical