MEDICARE: YVETTE A CANALS-WILLETTE LCSW, LMFT

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	SW0001982	FL

General Provider Information

NPI Number	:	1548312325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE A CANALS-WILLETTE LCSW, LMFT

Provider Business Mailing Address
First Line	:	6601 MEMORIAL HWY
Second Line	:	SUITE 220
City	:	TAMPA
State	:	FL
Zip	:	33615-4501
Country	:	US
Telephone Number	:	813-886-0000
Fax Number	:	812-237-2024

Provider Business Practice Location Address
First Line	:	6601 MEMORIAL HWY
Second Line	:	SUITE 220
City	:	TAMPA
State	:	FL
Zip	:	33615-4501
Country	:	US
Telephone Number	:	813-886-0000
Fax Number	:	812-237-2024

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/25/2009

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