Healthcare Provider Details

I. General information

NPI: 1396020988
Provider Name (Legal Business Name): PETER ADAM KANTROWITZ LCSW-R, CSSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WASHINTON AVENUE
ALBANY NY
12203
US

IV. Provider business mailing address

32 DOUGLAS RD
DELMAR NY
12054-3123
US

V. Phone/Fax

Practice location:
  • Phone: 518-454-3987
  • Fax: 518-437-0476
Mailing address:
  • Phone: 518-439-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number73065254
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: