Provider Demographics
NPI:1295719045
Name:CANNARIATO, ROBYN (LSW)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:CANNARIATO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 38 ABERDEEN ROAD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA ESTATES
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-380-7126
Mailing Address - Fax:718-380-0835
Practice Address - Street 1:184 38 ABERDEEN ROAD
Practice Address - Street 2:
Practice Address - City:JAMAICA ESTATES
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-380-7126
Practice Address - Fax:718-380-0835
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO4877611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02799Medicare ID - Type Unspecified