Provider Demographics
NPI:1215256961
Name:CANAVAN, JOSEPH THOMAS (LMHC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:CANAVAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4395 55TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-2425
Mailing Address - Country:US
Mailing Address - Phone:772-257-5808
Mailing Address - Fax:
Practice Address - Street 1:820 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6562
Practice Address - Country:US
Practice Address - Phone:772-569-9788
Practice Address - Fax:772-569-2088
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health