Provider Demographics
NPI:1902619042
Name:CAVALCANTE KRAUSE, FERNANDO (PHD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:CAVALCANTE KRAUSE
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 1:500 PECONIC ST APT 207A
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7146
Mailing Address - Country:US
Mailing Address - Phone:516-522-0532
Mailing Address - Fax:
Practice Address - Street 1:30 GLEN HEAD RD
Practice Address - Street 2:SUITE 3 EAST
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-522-0532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02687501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical