Provider Demographics
NPI:1396853214
Name:STANCARONE, MICHAEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:STANCARONE
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 1:666 PELHAM RD
Mailing Address - Street 2:3L
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1041
Mailing Address - Country:US
Mailing Address - Phone:914-576-2291
Mailing Address - Fax:914-632-1749
Practice Address - Street 1:666 PELHAM RD
Practice Address - Street 2:3L
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1041
Practice Address - Country:US
Practice Address - Phone:914-576-2291
Practice Address - Fax:914-632-1749
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V94341Medicare ID - Type Unspecified