Healthcare Provider Details

I. General information

NPI: 1194993964
Provider Name (Legal Business Name): T. STEVEN CANTLEY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS S CANTLEY LSW

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PRIVATE RD. 977
PEDRO OH
45659
US

IV. Provider business mailing address

115 PRIVATE RD. 977
PEDRO OH
45659
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-1386
  • Fax: 740-534-1497
Mailing address:
  • Phone: 740-534-1386
  • Fax: 740-534-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.0031730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: