MEDICARE: DR. JOSEPH CANTRELL PHD

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	103T00000X	Psychologist	4806	OH

General Provider Information

NPI Number	:	1467819649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH CANTRELL PHD

Provider Business Mailing Address
First Line	:	6365 HARLEM RD
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9707
Country	:	US
Telephone Number	:	614-855-2102
Fax Number	:

Provider Business Practice Location Address
First Line	:	6365 HARLEM RD
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-9707
Country	:	US
Telephone Number	:	614-855-2102
Fax Number	:

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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Directions to “ DR. JOSEPH CANTRELL PHD” Practice Location

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