Healthcare Provider Details

I. General information

NPI: 1609603190
Provider Name (Legal Business Name): BARBRA CANALE-DIGIOVANNA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 SMITHTOWN BYP STE 202
SMITHTOWN NY
11787-5011
US

IV. Provider business mailing address

496 SMITHTOWN BYP STE 202
SMITHTOWN NY
11787-5011
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-2223
  • Fax: 631-360-2288
Mailing address:
  • Phone: 631-360-2223
  • Fax: 631-360-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: