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General NPI Number Information
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NPI Number | 1801935010
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Entity Type | Individual
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Provider Name | COLLEEN H CANYON LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 03/23/2025
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Provider Practice Location Address
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Address Line | 220 9TH ST
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City | JERSEY CITY
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State | NJ
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Zip | 07302-4288
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Country | US
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Telephone | 929-992-0935
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Fax |
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Provider Business Mailing Address
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Address Line | 394 MOUNTAIN ROAD
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City | UNION CITY
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State | NJ
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Zip | 07087
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Country | US
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Telephone | 917-881-8096
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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 | 098837
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00019300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 001473
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06373900
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License Number State | NJ
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