MEDICARE: MR. KEVIN M. MCCLOAT CASAC-T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	37076	NY

General Provider Information

NPI Number	:	1033834072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN M. MCCLOAT CASAC-T

Provider Business Mailing Address
First Line	:	942 ROUTE 376 STE 201
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-6493
Country	:	US
Telephone Number	:	845-765-2366
Fax Number	:	845-765-2367

Provider Business Practice Location Address
First Line	:	942 ROUTE 376 STE 201
Second Line	:
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-6493
Country	:	US
Telephone Number	:	845-765-2366
Fax Number	:	845-765-2367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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