Provider Demographics
NPI:1750957817
Name:CANCEL, JUSTIN GEORGE (MSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:GEORGE
Last Name:CANCEL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175F CENTRE ST APT 610
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-8612
Mailing Address - Country:US
Mailing Address - Phone:773-580-9249
Mailing Address - Fax:
Practice Address - Street 1:1501 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7599
Practice Address - Country:US
Practice Address - Phone:617-847-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty