Healthcare Provider Details

I. General information

NPI: 1063576262
Provider Name (Legal Business Name): ANNE C WANDRES LCAT CASAC LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GOLDEN HILL LANE UCMH
KINGSTON NY
12401
US

IV. Provider business mailing address

110 RIVER RD
NEW PALTZ NY
12561
US

V. Phone/Fax

Practice location:
  • Phone: 845-340-4155
  • Fax: 845-340-4094
Mailing address:
  • Phone: 845-658-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4642
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: