Provider Demographics
NPI:1639286206
Name:MCCANN, MICHAEL JAMES (PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCCANN
Suffix:
Gender:M
Credentials:PH D
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Mailing Address - Street 1:107 VLY POINT DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1643
Mailing Address - Country:US
Mailing Address - Phone:518-339-5177
Mailing Address - Fax:518-633-1218
Practice Address - Street 1:113 HOLLAND AVE # 116A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3410
Practice Address - Country:US
Practice Address - Phone:518-626-5425
Practice Address - Fax:518-633-1218
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2021-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY014856103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist