Provider Demographics
NPI:1598984932
Name:DICANIO, GABRIELLE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:R
Last Name:DICANIO
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 1:34 OSAGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2036
Mailing Address - Country:US
Mailing Address - Phone:516-319-0576
Mailing Address - Fax:
Practice Address - Street 1:346A FRONT STREET
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:516-292-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-016934101YS0200X, 103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103TH0100XOtherHEALTH SERVICE
NY103TSO200XOtherSCHOOL PSYCHOLOGIST
NY103T00000XOtherPSYCHOLOGIST