Provider Demographics
NPI:1558608729
Name:KANAAN, PAULA RENEE (LMSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RENEE
Last Name:KANAAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 E MICHIGAN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1462
Mailing Address - Country:US
Mailing Address - Phone:269-340-0665
Mailing Address - Fax:
Practice Address - Street 1:1519 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1377
Practice Address - Country:US
Practice Address - Phone:269-273-2024
Practice Address - Fax:269-273-3191
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010926141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical