Individual provider Active NPI

Charles Thomas Capanzano, PH.D.

  • Clinical Psychologist
  • Cortland, NY
National Provider Identifier
1326150996
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
005561-1 Issued in NY
Practice address
7 Clayton Ave
Cortland, NY 13045-2501
Phone
(607) 758-6100
Fax
(607) 758-6116
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 005561-1 NY Primary

Addresses

Primary practice location

7 Clayton Ave
Cortland, NY 13045-2501

Mailing address

7 Clayton Ave
Cortland, NY 13045-2501
Phone (607) 758-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071022000695 NY Practitioner - Clinical Psychologist 8527962471 Practice locations: Cortland, NY

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

17 Main St
Suite 202
Cortland, NY 13045-6618
Phone (607) 622-0209

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
005561-1NYMDOccupational Therapist

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326150996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 CLAYTON AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130452501",
            "telephone_number": "607-758-6100",
            "fax_number": "607-758-6116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 CLAYTON AVE",
            "city": "CORTLAND",
            "state": "NY",
            "postal_code": "130452501",
            "telephone_number": "607-758-6100",
            "fax_number": "607-758-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAPANZANO",
        "first_name": "CHARLES",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "005561-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cortland, NY

Sources for this page

Verify at the official NPI Registry.