Provider Demographics
NPI:1225220072
Name:CANINO LCSW PSYCHOTHERAPY PC
Entity Type:Organization
Organization Name:CANINO LCSW PSYCHOTHERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:CANINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-543-1011
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1442
Mailing Address - Country:US
Mailing Address - Phone:917-543-1011
Mailing Address - Fax:718-852-6921
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 3C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1442
Practice Address - Country:US
Practice Address - Phone:917-543-1011
Practice Address - Fax:718-852-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069434302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY545926OtherVALUE OPTIONS
NY7349398OtherGHI
NYP3369526OtherOXFORD