Provider Demographics
NPI:1508049602
Name:CANIN, JON SAMUEL (PHD)
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:SAMUEL
Last Name:CANIN
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 1:350 NORTHERN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1000
Mailing Address - Country:US
Mailing Address - Phone:518-273-0491
Mailing Address - Fax:518-426-7701
Practice Address - Street 1:350 NORTHERN BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1000
Practice Address - Country:US
Practice Address - Phone:518-273-0491
Practice Address - Fax:518-426-7701
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist