Provider Demographics
NPI:1326762964
Name:CANALES, GEOFFREY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:
Last Name:CANALES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 HUNTING HILL AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4361
Mailing Address - Country:US
Mailing Address - Phone:203-843-6235
Mailing Address - Fax:
Practice Address - Street 1:339 HUNTING HILL AVE APT 5
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4361
Practice Address - Country:US
Practice Address - Phone:203-843-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5214104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty