Provider Demographics
NPI:1144317835
Name:CANTOR, LARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:CANTOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LIME QUARRY RD
Mailing Address - Street 2:STE 116
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-461-8896
Mailing Address - Fax:256-461-8897
Practice Address - Street 1:190 LIME QUARRY RD.
Practice Address - Street 2:STE 116
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-461-8896
Practice Address - Fax:256-461-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL851101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-99661OtherFEDERAL BLUE CROSS NO