Provider Demographics
NPI:1043274020
Name:CANTELLA, KRISTIN NICOLE (MFT)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:CANTELLA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 ENCINAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2509
Mailing Address - Country:US
Mailing Address - Phone:626-824-8572
Mailing Address - Fax:
Practice Address - Street 1:410 ARDEN AVE STE 201
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4006
Practice Address - Country:US
Practice Address - Phone:626-824-8572
Practice Address - Fax:818-637-7730
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40122106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist