Provider Demographics
NPI:1487105060
Name:CANTOR, DANIEL (PSY D)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CANTOR
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S 50TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1689
Mailing Address - Country:US
Mailing Address - Phone:215-242-2235
Mailing Address - Fax:
Practice Address - Street 1:7500 GERMANTOWN AVE
Practice Address - Street 2:ELDERS HALL, SUITE 5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1600
Practice Address - Country:US
Practice Address - Phone:267-417-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017863103T00000X
PA17863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist