Healthcare Provider Details

I. General information

NPI: 1750965547
Provider Name (Legal Business Name): MICHAEL PAUL O'KANE PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2021
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 LEXINGTON AVE RM 14A
NEW YORK NY
10017-6526
US

IV. Provider business mailing address

48 BIBBINS RD
EASTON CT
06612-1344
US

V. Phone/Fax

Practice location:
  • Phone: 212-204-8430
  • Fax:
Mailing address:
  • Phone: 203-767-7805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number026808
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4981
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: