Provider Demographics
NPI:1538388541
Name:CANCRO, PAUL T (MSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:T
Last Name:CANCRO
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 1:18 SKY HILL DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1817
Mailing Address - Country:US
Mailing Address - Phone:203-755-4490
Mailing Address - Fax:
Practice Address - Street 1:50 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1402
Practice Address - Country:US
Practice Address - Phone:203-755-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical