Provider Demographics
NPI:1225020126
Name:KANETZKY, NANCY (MSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:KANETZKY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:TARBAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2541
Mailing Address - Country:US
Mailing Address - Phone:845-452-1110
Mailing Address - Fax:845-452-1119
Practice Address - Street 1:230 NORTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1328
Practice Address - Country:US
Practice Address - Phone:845-486-2703
Practice Address - Fax:845-486-2865
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070643-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070643-1OtherMSW LICENSE