Healthcare Provider Details

I. General information

NPI: 1831105469
Provider Name (Legal Business Name): JOSEPH S. CANEVELLO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CRYSTAL POINT DR STE 3
CRYSTAL LAKE IL
60014-1400
US

IV. Provider business mailing address

610 CRYSTAL POINT DR STE 3
CRYSTAL LAKE IL
60014-1400
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-2270
  • Fax: 815-477-2287
Mailing address:
  • Phone: 815-477-2270
  • Fax: 815-477-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: