Basic Information
| Provider Information | |||||||||
| NPI: | 1598984932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICANIO | ||||||||
| FirstName: | GABRIELLE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 OSAGE DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON STATION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117462036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163190576 | ||||||||
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| Practice Location | |||||||||
| Address1: | 346A FRONT STREET | ||||||||
| Address2: | |||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162927111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 68-016934 | NY | X | Behavioral Health & Social Service Providers | Counselor | School | 103T00000X | 68-016934 | NY | X | Behavioral Health & Social Service Providers | Psychologist | 103TH0100X | 68-016934 | NY | X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
ID Information
| ID | Type | State | Issuer | Description | 103TH0100X | 01 | NY | HEALTH SERVICE | OTHER | 103TSO200X | 01 | NY | SCHOOL PSYCHOLOGIST | OTHER | 103T00000X | 01 | NY | PSYCHOLOGIST | OTHER |