Healthcare Provider Details

I. General information

NPI: 1518439298
Provider Name (Legal Business Name): MICHAEL CANNONE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 MAIN ST
BINGHAMTON NY
13905-2611
US

IV. Provider business mailing address

165 MAIN ST. STE A
CORTLAND NY
13045-3049
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-6206
  • Fax:
Mailing address:
  • Phone: 607-753-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number095617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: