Gary Paul Kanabay, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001188 Issued in CT

Practice address

207 Storrs Rd # 174
Mansfield Center, CT 06250-1638

Phone

(860) 456-4604

Fax

(860) 456-1738

NPI assigned

Sep 21, 2006

Last updated

May 1, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Professional Resource Group PC

  • Clinical Psychologist
  • Mansfield Center, CT
  • NPI 1710019963
  Authorized official Same address or phone

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1164521753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 STORRS RD # 174",
            "city": "MANSFIELD CENTER",
            "state": "CT",
            "postal_code": "062501638",
            "telephone_number": "860-456-4604",
            "fax_number": "860-456-1738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 STORRS RD # 174",
            "city": "MANSFIELD CENTER",
            "state": "CT",
            "postal_code": "062501638",
            "telephone_number": "860-456-4604",
            "fax_number": "860-456-1738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANABAY",
        "first_name": "GARY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Joy Jacobs
• Cheryl L Jacques, APRN
• David A Jaworski, M.D.
• Thamara Vanessa Jonathas, APRN
• Amanda Jones
• Jacqueline Vaccari Keating
• Ronald Wolz Kelly, M.D.
• Lorraine Marie Kenowski, MA, LPC
• Rachael Ann Kenowski, BSN, RN
• Kerith Brook CFC

• Clinical Psychologist in Mansfield Center, CT
• Providers in Mansfield Center, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; 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.