1992928394 NPI number — MR. RONALD CANTONE PSY.D,LMFT

Table of content: MR. RONALD CANTONE PSY.D,LMFT (NPI 1992928394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992928394 NPI number — MR. RONALD CANTONE PSY.D,LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTONE
Provider First Name:
RONALD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D,LMFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992928394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
493 EASTLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-7480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-732-0995
Provider Business Mailing Address Fax Number:
208-732-0993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
493 EASTLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-7480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-732-0995
Provider Business Practice Location Address Fax Number:
208-732-0993
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  LMFT-2687 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: LMFT-2687 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805997100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010138522 . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 481086633 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 002082395 . This is a "FIRST HEALTH" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: Q7421 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: X5952 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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