Provider Demographics
NPI:1255460028
Name:CANZONA, AMY MARIE (PLMHP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:CANZONA
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 33 BOX 25B
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NE
Mailing Address - Zip Code:69301-8900
Mailing Address - Country:US
Mailing Address - Phone:308-762-3818
Mailing Address - Fax:
Practice Address - Street 1:1015 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NE
Practice Address - Zip Code:69301-2759
Practice Address - Country:US
Practice Address - Phone:308-762-2956
Practice Address - Fax:308-762-3733
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252035-00Medicaid