Provider Demographics
NPI:1922145390
Name:MCCANN, JOHN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MCCANN
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 1:1087 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2109
Mailing Address - Country:US
Mailing Address - Phone:516-823-0023
Mailing Address - Fax:516-823-3373
Practice Address - Street 1:1087 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2109
Practice Address - Country:US
Practice Address - Phone:516-823-0023
Practice Address - Fax:516-823-3373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015944103T00000X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
01594468OtherHEALTH INSURANCE PLAN
JM0V750L10OtherBLUE CROSS BLUE SHIELD
NY02590870Medicaid
79106400OtherAETNA
NYS15944-2BOtherWORKERS COMPENSATION
525632OtherVALUE OPTIONS
7345855OtherGROUP HEALTH INC.
79106400OtherAETNA
525632OtherVALUE OPTIONS
NYVWW171Medicare ID - Type Unspecified