Provider Demographics
NPI:1184275067
Name:CARDENAS, FRED B (LMSW)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:B
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:FEDERICO
Other - Middle Name:B
Other - Last Name:CARDENAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:702 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4610
Mailing Address - Country:US
Mailing Address - Phone:210-299-2400
Mailing Address - Fax:210-226-0108
Practice Address - Street 1:702 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4610
Practice Address - Country:US
Practice Address - Phone:210-299-2400
Practice Address - Fax:210-226-0108
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65395171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator