Healthcare Provider Details

I. General information

NPI: 1629988852
Provider Name (Legal Business Name): SALVADOR MARTINHO MATOS CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RAILROAD AVE
MIDDLETOWN NY
10940-4907
US

IV. Provider business mailing address

7 RAILROAD AVE
MIDDLETOWN NY
10940-4907
US

V. Phone/Fax

Practice location:
  • Phone: 845-554-2458
  • Fax: 845-393-8011
Mailing address:
  • Phone: 845-554-2458
  • Fax: 845-393-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number42016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: