Active NPI
Elizabeth J Cancel, BS
- Exercise & Sports Psychologist
- Saint Clair Shores, MI
National Provider Identifier
1912332693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Exercise & Sports Psychologist
- Practice address
- 21010 Saint Gertrude St
Saint Clair Shores, MI 48081-1170 - Phone
- (586) 350-5603
- NPI assigned
- Sep 12, 2013
- Last updated
- Sep 12, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Exercise & Sports Psychologist | 103TE1100X | NU | Primary |
Addresses
Primary practice location
21010 Saint Gertrude St
Saint Clair Shores, MI 48081-1170
Mailing address
21010 Saint Gertrude St
Saint Clair Shores, MI 48081-1170
Phone (586) 350-5603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1912332693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21010 SAINT GERTRUDE ST",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480811170",
"telephone_number": "586-350-5603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21010 SAINT GERTRUDE ST",
"city": "SAINT CLAIR SHORES",
"state": "MI",
"postal_code": "480811170",
"telephone_number": "586-350-5603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANCEL",
"first_name": "ELIZABETH",
"middle_name": "J",
"credential": "BS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-12",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "103TE1100X",
"taxonomy_group": "",
"desc": "Psychologist, Exercise & Sports",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Clair Shores, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.