Provider Demographics
NPI:1255697561
Name:CANAL, STEPHANIE BOISVERT (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:BOISVERT
Last Name:CANAL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 WINDY WAY
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070
Mailing Address - Country:US
Mailing Address - Phone:401-632-6670
Mailing Address - Fax:
Practice Address - Street 1:YOUTH ADVOCATE PROGRAMS, INC 1515 N FRONT STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1815
Practice Address - Country:US
Practice Address - Phone:717-232-3150
Practice Address - Fax:717-232-3127
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN44775363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health