Provider Demographics
NPI:1245448968
Name:CANNAVO, JOANNE MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:MARIE
Last Name:CANNAVO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4332
Mailing Address - Country:US
Mailing Address - Phone:716-816-5147
Mailing Address - Fax:
Practice Address - Street 1:1201 COLVIN BLVD STE 3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-1936
Practice Address - Country:US
Practice Address - Phone:716-877-1188
Practice Address - Fax:716-877-1187
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05464511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC1394Medicare ID - Type UnspecifiedPROVIDER NUMBER