Provider Demographics
NPI:1285117887
Name:CHURUKHA, CAANEN M (LSW)
Entity type:Individual
Prefix:
First Name:CAANEN
Middle Name:M
Last Name:CHURUKHA
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STONEY RUN RD APT 3
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-9338
Mailing Address - Country:US
Mailing Address - Phone:717-524-8165
Mailing Address - Fax:
Practice Address - Street 1:4309 LINGLESTOWN RD STE 214
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-8607
Practice Address - Country:US
Practice Address - Phone:717-412-4908
Practice Address - Fax:717-695-0853
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135307104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker