Provider Demographics
NPI:1396576245
Name:CANBY, NICHOLAS K (PHD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:K
Last Name:CANBY
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 1:1643 WARWICK AVE UNIT 145
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1525
Mailing Address - Country:US
Mailing Address - Phone:401-526-2030
Mailing Address - Fax:
Practice Address - Street 1:1643 WARWICK AVE UNIT 145
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1525
Practice Address - Country:US
Practice Address - Phone:401-526-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical