Provider Demographics
NPI:1063578037
Name:CANCELLARE, MARY DENISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:DENISE
Last Name:CANCELLARE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3528
Mailing Address - Country:US
Mailing Address - Phone:914-949-1439
Mailing Address - Fax:
Practice Address - Street 1:425 E 61ST ST
Practice Address - Street 2:PH 1307
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8722
Practice Address - Country:US
Practice Address - Phone:212-821-0621
Practice Address - Fax:212-821-0994
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016914103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist