Provider Demographics
NPI:1942347968
Name:CANESTRO, PATRICIA ANN (MASTERS IN COUSELING)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:CANESTRO
Suffix:
Gender:F
Credentials:MASTERS IN COUSELING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MAIN
Mailing Address - Street 2:MAIN STREET SUITE 2
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1470
Mailing Address - Country:US
Mailing Address - Phone:650-242-2449
Mailing Address - Fax:
Practice Address - Street 1:70 MAIN STREET
Practice Address - Street 2:70 MAIN STREET SUITE 2
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-1470
Practice Address - Country:US
Practice Address - Phone:650-242-2449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42188106H00000X
MA5853101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALICENSE NUMBER 42188OtherMARRIAGE FAMILY THERAPIST