Dolores Erika Cancino, LCSW-BACS

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904017043 Issued in VA

Practice address

5213 Jerral Drive
Prince George, VA 23875

Phone

(307) 240-0879

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Ms. Dolores Cancino Clemons Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1346346525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 JERRAL DRIVE",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "23875",
            "telephone_number": "307-240-0879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5213 JERRAL DRIVE",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "23875",
            "telephone_number": "307-240-0879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANCINO",
        "first_name": "DOLORES",
        "middle_name": "ERIKA",
        "name_prefix": "Ms.",
        "credential": "LCSW-BACS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "LA",
            "license": "6168",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904017043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOLORES",
            "last_name": "CLEMONS",
            "middle_name": "CANCINO",
            "prefix": "MS.",
            "credential": "LCSW-BACS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Melba Williams Bryant
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• Mallory Taylor Cain, PA
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• Melaney A Caldwell, MD
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• Carp Services LLC
• Central Virginia Health Services Inc
• Dale Marie Chatman, LPC
• Carol Jean Cherich, LPC-LADAC

• Clinical Social Worker in Prince George, VA
• Providers in Prince George, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.