Provider Demographics
NPI:1821180456
Name:CANNAVA, JOSEPH J (MS,LPCS, CDCS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:CANNAVA
Suffix:
Gender:M
Credentials:MS,LPCS, CDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37426 DENISE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9087
Mailing Address - Country:US
Mailing Address - Phone:907-598-0030
Mailing Address - Fax:888-334-8293
Practice Address - Street 1:508 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6940
Practice Address - Country:US
Practice Address - Phone:907-598-0030
Practice Address - Fax:888-334-8293
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK482101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMHO156Medicaid
AK0000WCGTWMedicare ID - Type UnspecifiedPART B