Healthcare Provider Details

I. General information

NPI: 1295820512
Provider Name (Legal Business Name): KENNETH A. OCLATIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 VASSAR ST STE 35
POUGHKEEPSIE NY
12601-3022
US

IV. Provider business mailing address

57 N PARSONAGE ST
RHINEBECK NY
12572-1221
US

V. Phone/Fax

Practice location:
  • Phone: 845-389-1475
  • Fax: 845-876-1342
Mailing address:
  • Phone: 845-876-7349
  • Fax: 845-876-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number005723-1
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: