Provider Demographics
NPI:1396950721
Name:CANTAGALLO, DAVID (LCMHC,LADAC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CANTAGALLO
Suffix:
Gender:M
Credentials:LCMHC,LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SUNAPEE HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:SUNAPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03782-2927
Mailing Address - Country:US
Mailing Address - Phone:603-763-9369
Mailing Address - Fax:603-763-9369
Practice Address - Street 1:18 SUNAPEE HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:SUNAPEE
Practice Address - State:NH
Practice Address - Zip Code:03782-2927
Practice Address - Country:US
Practice Address - Phone:603-763-9369
Practice Address - Fax:603-763-9369
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422503Medicaid