Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | 006658 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 006658 | NY |
Y | 103G00000X | Clinical Psychologist | 006658 | NY |
Y | 103TC0700X | Clinical Psychologist | 006658 | NY |
N | 103TF0000X | Family Psychologist | 006658 | NY |
N | 103TR0400X | Rehabilitation Psychologist | 006658 | NY |
NPI | 1649254970 |
---|---|
Provider Name | Dr. Peter S Kanaris |
First Address | Smithtown, NY 11787-5005 |
Second Address | Smithtown, NY 11787-5005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00600091 | (05) | NY |