Individual
DR. GARY PAUL KANABAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
207 STORRS RD # 174, MANSFIELD CENTER, CT 06250-1638
(860) 456-4604
(860) 456-1738
Mailing address
207 STORRS RD # 174, MANSFIELD CENTER, CT 06250-1638
(860) 456-4604
(860) 456-1738
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001188
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004070595
—
CT
01
—
060001188CT01
ANTHEM
CT
01
—
080329
MHN
—
01
—
107944
VALUE OPTIONS
—
01
—
2448873
AETNA
—
01
—
C007612
TRICARE
—
Enumeration date
09/21/2006
Last updated
05/01/2014
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