Provider Demographics
NPI:1528086691
Name:CARDINAL, ANNE MARIE (CISW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:CARDINAL
Suffix:
Gender:F
Credentials:CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1814
Mailing Address - Fax:602-933-1820
Practice Address - Street 1:560 W BROWN RD
Practice Address - Street 2:#4007
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3221
Practice Address - Country:US
Practice Address - Phone:602-470-5520
Practice Address - Fax:480-649-0783
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0741I1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ761868Medicaid
AZ761868Medicaid
AZZ144865Medicare PIN