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NPI Code Detail

MEDICARE: MARK B CANTALES, LICENSED CLINICAL SOCIAL WORKER,PC

MEDICARE: MARK B CANTALES, LICENSED CLINICAL SOCIAL WORKER,PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker069788RNY

General Provider Information

NPI Number : 1164800553
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARK B CANTALES, LICENSED CLINICAL SOCIAL WORKER,PC
Provider Business Mailing Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-372-1020
Fax Number : 607-239-5328
Provider Business Practice Location Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-372-1020
Fax Number : 607-239-5328
Authorized Official
Title or Position : PRESIDENT
Name : MARK CANTALES
Credential : LCSWR
Telephone Number : 607-372-1020
Provider Enumeration Date : 05/18/2015
Last Update Date : 05/18/2015

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