Provider Demographics
NPI:1588894521
Name:CARDENAS, ANTIONETTE (DSW)
Entity type:Individual
Prefix:DR
First Name:ANTIONETTE
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3778 W 70TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3390
Mailing Address - Country:US
Mailing Address - Phone:219-718-7506
Mailing Address - Fax:219-500-2932
Practice Address - Street 1:3778 W 70TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3390
Practice Address - Country:US
Practice Address - Phone:219-718-7506
Practice Address - Fax:219-500-2932
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0278311041C0700X
IN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical