Provider Demographics
NPI:1598890998
Name:ANDEE CANTAVERO, LCSW
Entity Type:Organization
Organization Name:ANDEE CANTAVERO, LCSW
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDEE
Authorized Official - Middle Name:KRISTEN
Authorized Official - Last Name:CANTAVERO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-912-8195
Mailing Address - Street 1:116 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2245
Mailing Address - Country:US
Mailing Address - Phone:203-912-8195
Mailing Address - Fax:
Practice Address - Street 1:2001 W MAIN ST STE 106C
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-4547
Practice Address - Country:US
Practice Address - Phone:203-912-8195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty