MEDICARE: CANO FAMILY SERVICES, PLLC

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
1	1041C0700X	Clinical Social Worker	C009256	NC
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194119131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANO FAMILY SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2812 ISLAND POINT DR NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-2537
Country	:	US
Telephone Number	:	980-621-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 J N PEASE PL STE 101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4509
Country	:	US
Telephone Number	:	980-313-3020
Fax Number	:	704-980-8023

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ANGELA M CANO-JOHNSON
Credential	:	LCSW
Telephone Number	:	980-621-8401

Provider Enumeration Date	:	03/27/2015
Last Update Date	:	05/01/2022

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