Provider Demographics
NPI:1720418536
Name:CANADA, CHERYL (MSW,LSW,CCM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CANADA
Suffix:
Gender:F
Credentials:MSW,LSW,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 W. SHERMAN AVE.
Mailing Address - Street 2:CASE MANAGEMENT
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-696-7100
Mailing Address - Fax:
Practice Address - Street 1:1237 W. SHERMAN AVE.
Practice Address - Street 2:CASE MANAGEMENT
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-696-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL00218900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker