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NPI Code Detail

MEDICARE: MRS. KAREN MARIE GANNON CSP

MEDICARE: MRS. KAREN MARIE GANNON CSP
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
1103TS0200XSchool Psychologist1937289NY

General Provider Information

NPI Number : 1346493434
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAREN MARIE GANNON CSP
Provider Business Mailing Address
First Line : 40 JON BARRETT RD
Second Line :
City : PATTERSON
State : NY
Zip : 12563-2164
Country : US
Telephone Number : 845-878-9078
Fax Number : 845-278-6984
Provider Business Practice Location Address
First Line : 15 MOUNT EBO RD S
Second Line :
City : BREWSTER
State : NY
Zip : 10509-4004
Country : US
Telephone Number : 845-878-9078
Fax Number : 845-278-6984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2008
Last Update Date : 11/03/2008

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