Provider Demographics
NPI:1609018837
Name:CANTON, MARIE ROSE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ROSE
Last Name:CANTON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NEPONSET AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3321
Mailing Address - Country:US
Mailing Address - Phone:857-598-4774
Mailing Address - Fax:857-598-4816
Practice Address - Street 1:51 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3321
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:857-598-4816
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN235988363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health