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General NPI Number Information
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NPI Number | 1508311507
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Entity Type | Individual
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Provider Name | KATHLEEN CANTON
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Gender | Female
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 1009 MAITLAND CENTER COMMONS BLVD #212
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City | MAITLAND
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State | FL
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Zip | 32751-7270
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Country | US
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Telephone | 800-840-2528
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Fax |
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Provider Business Mailing Address
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Address Line | 9896 CARDINAL RD
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City | FAIRFAX
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State | VA
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Zip | 22030-1920
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Country | US
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Telephone | 407-756-7229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904012920
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License Number State | VA
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