Provider Demographics
NPI:1164461711
Name:CABASSO, ARNOLD (PHD)
Entity Type:Individual
Prefix:
First Name:ARNOLD
Middle Name:
Last Name:CABASSO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38-46 TIERNEY PL
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5126
Mailing Address - Country:US
Mailing Address - Phone:201-791-7451
Mailing Address - Fax:
Practice Address - Street 1:3 ALICE DR
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1722
Practice Address - Country:US
Practice Address - Phone:845-536-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010543-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01296928Medicaid
NY01296928Medicaid
NYV73591Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGY