Provider Demographics
NPI:1821170630
Name:CANTOR, JAY ROBERT (CSW)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ROBERT
Last Name:CANTOR
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 BRIER AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-1963
Mailing Address - Country:US
Mailing Address - Phone:215-518-9197
Mailing Address - Fax:
Practice Address - Street 1:590 NAAMANS RD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2308
Practice Address - Country:US
Practice Address - Phone:833-886-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134571041C0700X
DEQ1-00004711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEQ1-0000471Medicaid