Provider Demographics
NPI:1538708722
Name:CANAS, MADELAINE
Entity type:Individual
Prefix:
First Name:MADELAINE
Middle Name:
Last Name:CANAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17500 SW 68TH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1924
Mailing Address - Country:US
Mailing Address - Phone:954-401-9881
Mailing Address - Fax:
Practice Address - Street 1:17500 SW 68TH CT
Practice Address - Street 2:
Practice Address - City:SOUTHWEST RANCHES
Practice Address - State:FL
Practice Address - Zip Code:33331-1924
Practice Address - Country:US
Practice Address - Phone:954-401-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2025-02-13
Deactivation Date:2023-11-13
Deactivation Code:
Reactivation Date:2025-01-29
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 261QM0801X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty