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1124900816 NPI number — HARRY L GORDONEL CASAC T / CPRA

NPI Number: 1124900816
Health Care Provider/Practitioner: HARRY L GORDONEL CASAC T / CPRA

Information about “1124900816” NPI (HARRY L GORDONEL CASAC T / CPRA) exists in 1124900816 in HTML format HTML  |  1124900816 in plain Text format TXT  |  1124900816 in PDF (Portable Document Format) PDF  |  1124900816 in an XML format XML  formats.

NPI Number : 1124900816 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124900816",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GORDONEL",
    "FirstName": "HARRY",
    "MiddleName": "L",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CASAC T / CPRA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GORDONEL",
    "OtherFirstName": "HARRY",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "CASAC T / CPRA",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "15 FORTUNE RD W",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIDDLETOWN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "10941-1625",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "845-281-4393",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "15 FORTUNE RD W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIDDLETOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "10941-1625",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "845-281-4393",
    "PracticeLocationAddressFaxNumber": "845-692-2889",
    "EnumerationDate": "07/23/2025",
    "LastUpdateDate": "07/23/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "35161",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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