Provider Demographics
NPI:1457532541
Name:CANFORA, JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:CANFORA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 REMSEN ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4926
Mailing Address - Country:US
Mailing Address - Phone:631-513-1375
Mailing Address - Fax:631-266-2412
Practice Address - Street 1:7 REMSEN ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4926
Practice Address - Country:US
Practice Address - Phone:631-513-1375
Practice Address - Fax:631-266-2412
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP062496-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY393339Medicaid