Provider Demographics
NPI:1639464068
Name:CANTRELL, MAUREEN ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANNE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RENA
Other - Middle Name:
Other - Last Name:CANTRELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:8321 JANCY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-7848
Mailing Address - Country:US
Mailing Address - Phone:512-573-1817
Mailing Address - Fax:
Practice Address - Street 1:8321 JANCY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-7848
Practice Address - Country:US
Practice Address - Phone:512-573-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical