Provider Demographics
NPI:1134854110
Name:CANALES, CONSETTA ANTOINETTE (LPCMH)
Entity type:Individual
Prefix:
First Name:CONSETTA
Middle Name:ANTOINETTE
Last Name:CANALES
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-1429
Mailing Address - Country:US
Mailing Address - Phone:814-952-6788
Mailing Address - Fax:
Practice Address - Street 1:1159 BUNKER HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9798
Practice Address - Country:US
Practice Address - Phone:814-952-6788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health