=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295820512
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH A. OCLATIS PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 11/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 VASSAR ST STE 35
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12601-3022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-389-1475
-----------------------------------------------------
Fax | 845-876-1342
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 N PARSONAGE ST
-----------------------------------------------------
City | RHINEBECK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12572-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-876-7349
-----------------------------------------------------
Fax | 845-876-1342
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 005723-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------