MEDICARE: DANIEL CANTOR 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	PS017863	PA
2	103TC0700X	Clinical Psychologist	17863	PA

General Provider Information

NPI Number	:	1487105060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL CANTOR PSY. D.

Provider Business Mailing Address
First Line	:	701 S 50TH ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1689
Country	:	US
Telephone Number	:	215-242-2235
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 GERMANTOWN AVE
Second Line	:	ELDERS HALL, SUITE 5
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1600
Country	:	US
Telephone Number	:	267-417-7476
Fax Number	:

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

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	12/19/2023

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