MEDICARE: DR. JOANNE MARIE CANNAVO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R0546451	NY

General Provider Information

NPI Number	:	1245448968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE MARIE CANNAVO PHD

Provider Business Mailing Address
First Line	:	65 WASHINGTON HWY
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-4332
Country	:	US
Telephone Number	:	716-816-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD STE 3
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-877-1188
Fax Number	:	716-877-1187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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