Provider Demographics
NPI:1720751092
Name:CANOVA, DOMINIC (PSYD, MSED, LPC)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:
Last Name:CANOVA
Suffix:
Gender:M
Credentials:PSYD, MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 10TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2924
Mailing Address - Country:US
Mailing Address - Phone:412-780-0583
Mailing Address - Fax:
Practice Address - Street 1:729 10TH ST APT 2E
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2924
Practice Address - Country:US
Practice Address - Phone:412-780-0583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-31
Last Update Date:2021-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00767400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health