Provider Demographics
NPI:1114232907
Name:CANTOR, SALLY LYNN (MSSW LISW)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:LYNN
Last Name:CANTOR
Suffix:
Gender:F
Credentials:MSSW LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 KINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-2819
Mailing Address - Country:US
Mailing Address - Phone:610-737-5357
Mailing Address - Fax:
Practice Address - Street 1:3200 KINGSLEY RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2819
Practice Address - Country:US
Practice Address - Phone:610-737-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0000301041C0700X
PACW007301L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical