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General NPI Number Information
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NPI Number | 1730002783
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Entity Type | Individual
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Provider Name | EDWARD CANTILLO LSW
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Gender | Male
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 638 NEWARK AVE STE 3
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City | JERSEY CITY
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State | NJ
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Zip | 07306-2306
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Country | US
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Telephone | 201-344-2350
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Fax |
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Provider Business Mailing Address
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Address Line | 232 FAIRWAY AVE
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1402
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Country | US
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Telephone | 551-220-8576
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 44SL07453400
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License Number State | NJ
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