Healthcare Provider Details

I. General information

NPI: 1255277802
Provider Name (Legal Business Name): JAMES THORPE III CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 LIBERTY ST
NEWBURGH NY
12550-4912
US

IV. Provider business mailing address

172 LIBERTY ST
NEWBURGH NY
12550-4912
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-5783
  • Fax: 845-393-8012
Mailing address:
  • Phone: 845-561-5783
  • Fax: 845-393-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number42151
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: