Provider Demographics
NPI:1275004012
Name:MARRERO-CANALES, YABNEEL (LCSW)
Entity Type:Individual
Prefix:
First Name:YABNEEL
Middle Name:
Last Name:MARRERO-CANALES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:CT
Mailing Address - Zip Code:06249-0223
Mailing Address - Country:US
Mailing Address - Phone:860-639-7711
Mailing Address - Fax:
Practice Address - Street 1:322 MAIN ST STE 1H
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-3152
Practice Address - Country:US
Practice Address - Phone:860-639-7711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT44401041C0700X
CT0111131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical