Provider Demographics
NPI:1598803249
Name:CANTLEY, CARYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARYN
Middle Name:
Last Name:CANTLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ULSTER CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4512
Mailing Address - Country:US
Mailing Address - Phone:631-462-0579
Mailing Address - Fax:
Practice Address - Street 1:23 ULSTER CT
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4512
Practice Address - Country:US
Practice Address - Phone:631-462-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool