Healthcare Provider Details

I. General information

NPI: 1891324562
Provider Name (Legal Business Name): COURTNEY KAY OCASIO LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 RISLEY RD
PATCHOGUE NY
11772-1525
US

IV. Provider business mailing address

41 RISLEY RD
PATCHOGUE NY
11772-1525
US

V. Phone/Fax

Practice location:
  • Phone: 631-394-1891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011956
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: