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NPI Code Detail

MEDICARE: MARK BLAINE CANTALES LCSWR

MEDICARE: MARK BLAINE CANTALES LCSWR
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
11041C0700XClinical Social Worker069788-1NY

General Provider Information

NPI Number : 1922162643
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK BLAINE CANTALES LCSWR
Provider Business Mailing Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-372-1020
Fax Number : 607-239-5328
Provider Business Practice Location Address
First Line : 217 JEFFERSON AVE
Second Line :
City : ENDICOTT
State : NY
Zip : 13760-5244
Country : US
Telephone Number : 607-372-1020
Fax Number : 607-239-5328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 02/20/2024

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Directions to “ MARK BLAINE CANTALES LCSWR” Practice Location

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