Provider Demographics
NPI:1013211440
Name:CANTARA, ALBERT ROLAND (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ROLAND
Last Name:CANTARA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 ROTAN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-4008
Mailing Address - Country:US
Mailing Address - Phone:512-630-0767
Mailing Address - Fax:
Practice Address - Street 1:6700 ROTAN DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-4008
Practice Address - Country:US
Practice Address - Phone:512-630-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist