Provider Demographics
NPI:1285725218
Name:CANCIENNE, JAMES CLARENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLARENCE
Last Name:CANCIENNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 W 35TH ST APT 5W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-1509
Mailing Address - Country:US
Mailing Address - Phone:518-821-5241
Mailing Address - Fax:
Practice Address - Street 1:680 W END AVE STE 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6815
Practice Address - Country:US
Practice Address - Phone:518-821-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014891-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596803Medicaid
NY534328OtherVALUEOPTIONS
NY785908OtherMVP
NY7346582OtherGHI
NY000410217001OtherBLUESHIELD OF NORTHEASTER