Provider Demographics
NPI:1821342965
Name:CANTEENWALLA, VICKI
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:CANTEENWALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N PRESSVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3811
Mailing Address - Country:US
Mailing Address - Phone:561-542-6531
Mailing Address - Fax:
Practice Address - Street 1:128 N PRESSVIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-3811
Practice Address - Country:US
Practice Address - Phone:561-542-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-26
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst