Healthcare Provider Details

I. General information

NPI: 1457364440
Provider Name (Legal Business Name): THOMAS ANTHONY CANALE MSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LEROY ST
BINGHAMTON NY
13905-4603
US

IV. Provider business mailing address

14 LEROY STREET
BINGHAMTON NY
13905-4603
US

V. Phone/Fax

Practice location:
  • Phone: 607-765-9259
  • Fax: 607-724-3865
Mailing address:
  • Phone: 607-765-9259
  • Fax: 607-724-3865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberR0380681
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: