Provider Demographics
NPI:1801149216
Name:CANONICA, MARIA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:CANONICA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:29 SCUDDERS LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1533
Mailing Address - Country:US
Mailing Address - Phone:201-790-1396
Mailing Address - Fax:
Practice Address - Street 1:29 SCUDDERS LN
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1533
Practice Address - Country:US
Practice Address - Phone:201-790-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0859151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical