MEDICARE: MARY CANANE LMHC

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	174400000X	Specialist	MH0002141	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	088446	OTHER	FL	VALUE OPTIONS
2	2719342	OTHER	FL	AETNA
3	239645000	OTHER	FL	MAGELLAN
4	124291	OTHER	FL	PSYCHCARE
5	6241056	OTHER	FL	UBH

General Provider Information

NPI Number	:	1194744789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CANANE LMHC

Provider Business Mailing Address
First Line	:	15895 66TH CT N
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-3426
Country	:	US
Telephone Number	:	561-795-9695
Fax Number	:	561-792-8865

Provider Business Practice Location Address
First Line	:	1480 ROYAL PALM BEACH BLVD.
Second Line	:	SUITE C
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1608
Country	:	US
Telephone Number	:	561-301-5355
Fax Number	:	561-792-8865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	02/09/2011

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Directions to “ MARY CANANE LMHC” Practice Location

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