Healthcare Provider Details

I. General information

NPI: 1992928394
Provider Name (Legal Business Name): RONALD CANTONE PSY.D,LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DR
TWIN FALLS ID
83301-7480
US

IV. Provider business mailing address

493 EASTLAND DR
TWIN FALLS ID
83301-7480
US

V. Phone/Fax

Practice location:
  • Phone: 208-732-0995
  • Fax: 208-732-0993
Mailing address:
  • Phone: 208-732-0995
  • Fax: 208-732-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLMFT-2687
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-2687
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: