Healthcare Provider Details

I. General information

NPI: 1639286206
Provider Name (Legal Business Name): MICHAEL JAMES MCCANN PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE # 116A
ALBANY NY
12208-3410
US

IV. Provider business mailing address

107 VLY POINT DR
NISKAYUNA NY
12309-1643
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-5425
  • Fax: 518-633-1218
Mailing address:
  • Phone: 518-339-5177
  • Fax: 518-633-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: