Provider Demographics
NPI:1780978411
Name:CANCEL, JAVIER EUGENIO (TAC, PHD-C)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:EUGENIO
Last Name:CANCEL
Suffix:
Gender:M
Credentials:TAC, PHD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:O1 CALLE ACROPOLIS
Mailing Address - Street 2:APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4918
Mailing Address - Country:US
Mailing Address - Phone:787-438-6749
Mailing Address - Fax:
Practice Address - Street 1:O1 CALLE ACROPOLIS
Practice Address - Street 2:APOLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4918
Practice Address - Country:US
Practice Address - Phone:787-438-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTAC-III-05-20-0332101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTAC-III-05-20-0332OtherTHERAPEUTIC ADDICTION COUNSELOR III