Healthcare Provider Details

I. General information

NPI: 1811798671
Provider Name (Legal Business Name): KIMM SHELLEY MCNEIL CASAS 2
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORPORATE DR # 3H
PEEKSKILL NY
10566-1846
US

IV. Provider business mailing address

121 HEMLOCK CIR
PEEKSKILL NY
10566-4903
US

V. Phone/Fax

Practice location:
  • Phone: 914-257-3500
  • Fax:
Mailing address:
  • Phone: 914-589-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5890
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: