Provider Demographics
NPI:1184048662
Name:LIFE'S CANVAS
Entity type:Organization
Organization Name:LIFE'S CANVAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:585-857-6122
Mailing Address - Street 1:261 S PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1749
Mailing Address - Country:US
Mailing Address - Phone:585-857-6122
Mailing Address - Fax:
Practice Address - Street 1:514 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-2246
Practice Address - Country:US
Practice Address - Phone:585-857-6122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty