Active NPI
Gary Paul Kanabay, PSY.D.
- Clinical Psychologist
- Mansfield Center, CT
National Provider Identifier
1164521753
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 001188
- Practice address
- 207 Storrs Rd # 174
Mansfield Center, CT 06250-1638 - Phone
- (860) 456-4604
- Fax
- (860) 456-1738
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001188 | CT | Primary |
Addresses
Primary practice location
207 Storrs Rd # 174
Mansfield Center, CT 06250-1638
Mailing address
207 Storrs Rd # 174
Mansfield Center, CT 06250-1638
Phone (860) 456-4604
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004070595 | Medicaid | CT | |
| 107944 | Other | VALUE OPTIONS | |
| 2448873 | Other | AETNA | |
| C007612 | Other | TRICARE | |
| 060001188CT01 | Other | CT | ANTHEM |
| 080329 | Other | MHN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1188 | CT | MD | Registered Dietitian |
| 001188 | CT | MD | Surgical Physician Assistant |
NPI Registry JSON
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004070595",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "107944",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2448873",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "C007612",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "060001188CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "080329",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Mansfield Center, CT
Sources for this page
- 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.