Healthcare Provider Details

I. General information

NPI: 1073400891
Provider Name (Legal Business Name): CARMEN CANALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 DIXWELL AVE STE 401
HAMDEN CT
06518-3195
US

IV. Provider business mailing address

200 KOHARY DR
NEW HAVEN CT
06515-2463
US

V. Phone/Fax

Practice location:
  • Phone: 203-693-1214
  • Fax:
Mailing address:
  • Phone: 203-503-8563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3973
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: