Provider Demographics
NPI:1144205105
Name:KANARIS PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:KANARIS PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KANARIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:631-979-2640
Mailing Address - Street 1:496 SMITHTOWN BYP
Mailing Address - Street 2:#304
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5005
Mailing Address - Country:US
Mailing Address - Phone:631-979-2640
Mailing Address - Fax:631-979-2684
Practice Address - Street 1:496 SMITHTOWN BYP
Practice Address - Street 2:#304
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5005
Practice Address - Country:US
Practice Address - Phone:631-979-2640
Practice Address - Fax:631-979-2684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV8W031Medicare ID - Type Unspecified