Organization
SOLE PROPRIETOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENDAN MICHAEL CANAVAN M.A. (ABSS)
(516) 770-2383
Entity
Organization
Contact information
Practice address
610 WILLIS AVE APT 1F, WILLISTON PARK, NY 11596-1221
(516) 770-2383
Mailing address
610 WILLIS AVE APT 1F, WILLISTON PARK, NY 11596-1221
(516) 770-2383
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
437022101
NY
Other
Enumeration date
02/28/2015
Last updated
02/28/2015
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