Provider Demographics
NPI:1649364266
Name:CANTAVERO, ANDEE KRISTEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANDEE
Middle Name:KRISTEN
Last Name:CANTAVERO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANDEE
Other - Middle Name:
Other - Last Name:CANTAVERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:116 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2245
Mailing Address - Country:US
Mailing Address - Phone:203-912-8195
Mailing Address - Fax:
Practice Address - Street 1:2001 WEST MAIN STREET
Practice Address - Street 2:SUITE 106B
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06830
Practice Address - Country:US
Practice Address - Phone:203-912-8195
Practice Address - Fax:203-625-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP056423101YM0800X
CT005379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health