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General NPI Number Information
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NPI Number | 1043489339
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Entity Type | Individual
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Provider Name | JONATHAN LEONARD KANEGSON PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 19 W 34TH ST SOCIOMETRIC INSTITUTE- PH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 212-947-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 239 E 88TH ST APT 4
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City | NEW YORK
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State | NY
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Zip | 10128-0907
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Country | US
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Telephone | 646-634-5080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21681
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8810
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY9535
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 017102
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License Number State | NY
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