Provider Demographics
NPI:1275624165
Name:CANO, GLADYS (LICSW)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:CANO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2225
Mailing Address - Country:US
Mailing Address - Phone:508-369-4225
Mailing Address - Fax:508-639-9629
Practice Address - Street 1:155 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2225
Practice Address - Country:US
Practice Address - Phone:508-369-4225
Practice Address - Fax:508-639-9629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118563101YM0800X
RIISW015381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGC49801Medicaid