Provider Demographics
NPI:1154618544
Name:CARDENAS, KEREN HAPUC
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:HAPUC
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4818
Mailing Address - Country:US
Mailing Address - Phone:331-575-5035
Mailing Address - Fax:224-653-8910
Practice Address - Street 1:1809 N MILL ST STE G
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4867
Practice Address - Country:US
Practice Address - Phone:331-575-5035
Practice Address - Fax:224-653-8910
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001515101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health