Basic Information
Provider Information
NPI: 1184378655
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CANAS
FirstName: KATHERINE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 354 WAVERLEY ST
Address2:  
City: FRAMINGHAM
State: MA
PostalCode: 017027079
CountryCode: US
TelephoneNumber: 5088723333
FaxNumber:  
Practice Location
Address1: 1881 WORCESTER RD
Address2:  
City: FRAMINGHAM
State: MA
PostalCode: 017015410
CountryCode: US
TelephoneNumber: 5086286300
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/04/2022
LastUpdateDate: 09/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home