Provider Demographics
NPI:1992891527
Name:CANUTESON-MORALES, ERIN (LCSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CANUTESON-MORALES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:CANUTESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6075 RAND BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238
Mailing Address - Country:US
Mailing Address - Phone:941-921-2792
Mailing Address - Fax:941-925-2438
Practice Address - Street 1:6075 RAND BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238
Practice Address - Country:US
Practice Address - Phone:941-921-2792
Practice Address - Fax:941-925-2438
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5W6528104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL245159OtherWELLCARE