Healthcare Provider Details

I. General information

NPI: 1871010595
Provider Name (Legal Business Name): GLORIA J CANNELORA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BUTTE ST
REDDING CA
96001-0852
US

IV. Provider business mailing address

PO BOX 990634
REDDING CA
96099-0634
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-8218
  • Fax:
Mailing address:
  • Phone: 530-722-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW74929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: