Provider Demographics
NPI:1649044850
Name:CANFIELD, ROOSEVELT PERNELL (BA SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:ROOSEVELT
Middle Name:PERNELL
Last Name:CANFIELD
Suffix:
Gender:M
Credentials:BA SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9713 DULCIMER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-3511
Mailing Address - Country:US
Mailing Address - Phone:318-547-6910
Mailing Address - Fax:
Practice Address - Street 1:9713 DULCIMER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77051-3511
Practice Address - Country:US
Practice Address - Phone:318-547-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator