| Doctor Name: | DR. GARY PAUL KANABAY |
| NPI Number: | 1164521753 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D. |
| License Number: | 001188 |
| Business Practice Address: | 207 Storrs Rd # 174 Mansfield Center, CT - 062501638 |
| Business Phone Number: | 8604564604 |
| Business Fax Number: | 8604561738 |
| Mailing Address: | 207 Storrs Rd # 174, MANSFIELD CENTER |
| State: | CT |
| Postal Code: | 062501638 |
| Phone Number: | 8604564604 |
| Fax Number: | 8604561738 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 05/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 001188 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |