Provider Demographics
NPI:1699969196
Name:CANEDO, VANESSA JUDITH
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:JUDITH
Last Name:CANEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4003
Mailing Address - Country:US
Mailing Address - Phone:718-561-4340
Mailing Address - Fax:718-561-3839
Practice Address - Street 1:7 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4003
Practice Address - Country:US
Practice Address - Phone:718-561-4340
Practice Address - Fax:718-561-3839
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0499101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1285628552OtherAGENCIES