Provider Demographics
NPI:1881339000
Name:CANO, MARYJANE ANESSA I (N/A)
Entity type:Individual
Prefix:MISS
First Name:MARYJANE
Middle Name:ANESSA
Last Name:CANO
Suffix:I
Gender:F
Credentials:N/A
Other - Prefix:MISS
Other - First Name:MARYJANE
Other - Middle Name:ANESSA
Other - Last Name:CANO
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:350 FAIRWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1834
Mailing Address - Country:US
Mailing Address - Phone:866-500-2186
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:1333 S MAYFLOWER AVE STE 220
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5239
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician