Healthcare Provider Details

I. General information

NPI: 1548033277
Provider Name (Legal Business Name): JUDITH DARLENE CANALES MA, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 8TH ST
LEBANON PA
17046-5011
US

IV. Provider business mailing address

311 WALNUT ST
LEMOYNE PA
17043-1647
US

V. Phone/Fax

Practice location:
  • Phone: 972-971-4988
  • Fax:
Mailing address:
  • Phone: 972-971-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: