Provider Demographics
NPI:1447352208
Name:CARDENAS, CHRISTINE DIANE (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DIANE
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 VIOLET LN
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9531
Mailing Address - Country:US
Mailing Address - Phone:610-345-9009
Mailing Address - Fax:
Practice Address - Street 1:31 VIOLET LN
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9531
Practice Address - Country:US
Practice Address - Phone:610-345-9009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0137081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA911031Medicaid
PA023677Medicare ID - Type Unspecified
PA911031Medicaid