MEDICARE: MS. BARBARA A CANNATA LCSW

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	CW016216	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CW016216	OTHER	PA	PA DEPT OF STATE BUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS

General Provider Information

NPI Number	:	1669521100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA A CANNATA LCSW

Provider Business Mailing Address
First Line	:	1611 PEACH ST
Second Line	:	SUITE 185
City	:	ERIE
State	:	PA
Zip	:	16501-2109
Country	:	US
Telephone Number	:	814-480-8985
Fax Number	:	814-480-8947

Provider Business Practice Location Address
First Line	:	1611 PEACH ST
Second Line	:	SUITE 185
City	:	ERIE
State	:	PA
Zip	:	16501-2109
Country	:	US
Telephone Number	:	814-480-8985
Fax Number	:	814-480-8947

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	05/18/2009

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