Provider Demographics
NPI:1528100120
Name:CANNELLA, VINCENT (BS)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:CANNELLA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MAHALANI ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2528
Mailing Address - Country:US
Mailing Address - Phone:808-243-1262
Mailing Address - Fax:
Practice Address - Street 1:121 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2528
Practice Address - Country:US
Practice Address - Phone:808-243-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker