Provider Demographics
NPI:1316616220
Name:CANTOS, JOSHUA BRANDON (MS, CASAC-T)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:BRANDON
Last Name:CANTOS
Suffix:
Gender:M
Credentials:MS, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163-18 JAMACIA AVENUE SUITE 502
Mailing Address - Street 2:
Mailing Address - City:JAMACIA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 FIRESTONE CIR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3047
Practice Address - Country:US
Practice Address - Phone:516-333-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36977101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)