Provider Demographics
NPI:1265539845
Name:DE LA CANCELA, VICTOR (PHD, MPH)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:DE LA CANCELA
Suffix:
Gender:
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DIANE CT
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7010
Mailing Address - Country:US
Mailing Address - Phone:917-374-8474
Mailing Address - Fax:914-737-0106
Practice Address - Street 1:6 DIANE CT
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7010
Practice Address - Country:US
Practice Address - Phone:917-374-8474
Practice Address - Fax:914-737-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010361-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical