Provider Demographics
NPI:1184176323
Name:CANNETTI, BREANNA (LSW)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CANNETTI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 MORRIS AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4852
Mailing Address - Country:US
Mailing Address - Phone:908-481-5050
Mailing Address - Fax:908-688-2505
Practice Address - Street 1:2780 MORRIS AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4852
Practice Address - Country:US
Practice Address - Phone:908-481-5050
Practice Address - Fax:908-688-2505
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06078100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker