Provider Demographics
NPI:1033402649
Name:CANONICA, DEBORAH (MS)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:CANONICA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MEADOWCREST LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9231
Mailing Address - Country:US
Mailing Address - Phone:610-716-5665
Mailing Address - Fax:610-269-0706
Practice Address - Street 1:803 MEADOWCREST LN
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-9231
Practice Address - Country:US
Practice Address - Phone:610-716-5665
Practice Address - Fax:610-269-0706
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst