Provider Demographics
NPI:1417789694
Name:CANADA AND ASSOCIATES LLC
Entity type:Organization
Organization Name:CANADA AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BC-ABA, LBS
Authorized Official - Phone:267-428-1202
Mailing Address - Street 1:7020 N BROAD ST APT C9
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19126-1719
Mailing Address - Country:US
Mailing Address - Phone:267-428-1202
Mailing Address - Fax:
Practice Address - Street 1:520 CARPENTER LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-3453
Practice Address - Country:US
Practice Address - Phone:267-428-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104372491Medicaid