Basic Information
Provider Information
NPI: 1063751691
EntityType: 2
ReplacementNPI:  
OrganizationName: GABRIELLE DICANIO-KIRBY
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GABRIELLE DICANIO
OtherOrganizationType: 4
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15 PEGS LN
Address2:  
City: COLD SPRING HARBOR
State: NY
PostalCode: 117242414
CountryCode: US
TelephoneNumber: 5163190576
FaxNumber:  
Practice Location
Address1: 15 PEGS LN
Address2:  
City: COLD SPRING HARBOR
State: NY
PostalCode: 117242414
CountryCode: US
TelephoneNumber: 5163190576
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/01/2013
LastUpdateDate: 05/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: DICANIO
AuthorizedOfficialFirstName: GABRIELLE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SCHOOL PSYCHOLOGIST
AuthorizedOfficialTelephone: 15163190576
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: PSY.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251300000X NYN AgenciesLocal Education Agency (LEA) 
252Y00000X68 016934NYY AgenciesEarly Intervention Provider Agency 

No ID Information.


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