Provider Demographics
NPI:1912332693
Name:CANCEL, ELIZABETH J (BS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:CANCEL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21010 SAINT GERTRUDE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1170
Mailing Address - Country:US
Mailing Address - Phone:586-350-5603
Mailing Address - Fax:
Practice Address - Street 1:21010 SAINT GERTRUDE ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1170
Practice Address - Country:US
Practice Address - Phone:586-350-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports