Basic Information
| Provider Information | |||||||||
| NPI: | 1841878519 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTADA | ||||||||
| FirstName: | RALPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 316 CATOR AVE | ||||||||
| Address2: | |||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073052004 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 395 GRAND ST | ||||||||
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| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073024238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019152000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SL06605100 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.