Healthcare Provider Details

I. General information

NPI: 1033834072
Provider Name (Legal Business Name): KEVIN M. MCCLOAT CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 ROUTE 376 STE 201
WAPPINGERS FALLS NY
12590-6493
US

IV. Provider business mailing address

942 ROUTE 376 STE 201
WAPPINGERS FALLS NY
12590-6493
US

V. Phone/Fax

Practice location:
  • Phone: 845-765-2366
  • Fax: 845-765-2367
Mailing address:
  • Phone: 845-765-2366
  • Fax: 845-765-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: