Provider Demographics
NPI:1063701910
Name:ARTIS, KENIA (MSW, CADC, CASAC)
Entity type:Individual
Prefix:MRS
First Name:KENIA
Middle Name:
Last Name:ARTIS
Suffix:
Gender:F
Credentials:MSW, CADC, CASAC
Other - Prefix:MS
Other - First Name:KENIA
Other - Middle Name:
Other - Last Name:VIDAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CADC, CASAC
Mailing Address - Street 1:19 E ORMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2053
Mailing Address - Country:US
Mailing Address - Phone:856-428-1300
Mailing Address - Fax:
Practice Address - Street 1:499 COOPER LANDING RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2504
Practice Address - Country:US
Practice Address - Phone:856-428-4357
Practice Address - Fax:856-665-5193
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00071000101YA0400X
NY17340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)