Provider Demographics
NPI:1760243547
Name:CANFIELD, CATHERINE JANE (LSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1060
Mailing Address - Country:US
Mailing Address - Phone:607-257-2045
Mailing Address - Fax:607-257-2049
Practice Address - Street 1:2309 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1060
Practice Address - Country:US
Practice Address - Phone:607-257-2045
Practice Address - Fax:607-257-2049
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139460104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker