Active NPI
Mary Denise Cancellare, PH.D.
- Psychologist
- New York, NY
National Provider Identifier
1063578037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 016914
- Practice address
- 425 E 61St St
PH 1307
New York, NY 10021-8722 - Phone
- (212) 821-0621
- Fax
- (212) 821-0994
- NPI assigned
- Dec 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 016914 | NY | Primary |
Addresses
Primary practice location
425 E 61St St
PH 1307
New York, NY 10021-8722
Mailing address
50 Park Ave
White Plains, NY 10603-3528
Phone (914) 949-1439
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016914 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063578037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 PARK AVE",
"city": "WHITE PLAINS",
"state": "NY",
"postal_code": "106033528",
"telephone_number": "914-949-1439"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 E 61ST ST",
"address_2": "PH 1307",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100218722",
"telephone_number": "212-821-0621",
"fax_number": "212-821-0994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CANCELLARE",
"first_name": "MARY",
"middle_name": "DENISE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "016914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.