Provider Demographics
NPI:1720171192
Name:CANARIO, GAIL ANN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:ANN
Last Name:CANARIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 N KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-8025
Mailing Address - Country:US
Mailing Address - Phone:941-708-6826
Mailing Address - Fax:
Practice Address - Street 1:1502 N KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-8025
Practice Address - Country:US
Practice Address - Phone:863-990-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4770101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
7606141Medicare ID - Type Unspecified