Provider Demographics
NPI:1245286483
Name:CANCILLA, DAVID F (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:CANCILLA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CANCILLA DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 459 APO AE
Practice Address - Street 2:11707
Practice Address - City:BAMBERG
Practice Address - State:WARNER BARRACKS
Practice Address - Zip Code:09139
Practice Address - Country:DE
Practice Address - Phone:0951-300-7793
Practice Address - Fax:0951-300-8022
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0146321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical