Provider Demographics
NPI:1538415450
Name:CANOSE, DAVID BRIAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:CANOSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVE
Mailing Address - Street 2:A216
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9196
Mailing Address - Country:US
Mailing Address - Phone:212-562-7445
Mailing Address - Fax:212-562-3809
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:A216
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-7445
Practice Address - Fax:212-562-3809
Is Sole Proprietor?:No
Enumeration Date:2012-07-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019775-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist