MEDICARE: DR. MICHELLE CANGELOSI PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	020325	NY

General Provider Information

NPI Number	:	1306373055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE CANGELOSI PSY.D.

Provider Business Mailing Address
First Line	:	95 HARRIET RD
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-4704
Country	:	US
Telephone Number	:	631-517-0662
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 FIRE ISLAND AVE STE 110
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3502
Country	:	US
Telephone Number	:	631-517-0662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	01/13/2020

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