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General NPI Number Information
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NPI Number | 1598890998
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Entity Type | Organization
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Legal Business Name | ANDEE CANTAVERO, LCSW
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2001 W MAIN ST STE 106C
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City | STAMFORD
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State | CT
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Zip | 06902-4547
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Country | US
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Telephone | 203-912-8195
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Fax |
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Provider Business Mailing Address
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Address Line | 116 INDIAN RD
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City | PORT CHESTER
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State | NY
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Zip | 10573-2245
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Country | US
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Telephone | 203-912-8195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDEE KRISTEN CANTAVERO
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Credential | LCSW
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Telephone | 203-912-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 005379
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License Number State | CT
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