Provider Demographics
NPI:1154665321
Name:SPATH, KEVIN J (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:SPATH
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HALSTEAD ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3508
Mailing Address - Country:US
Mailing Address - Phone:914-419-3004
Mailing Address - Fax:
Practice Address - Street 1:210 HALSTEAD ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-3508
Practice Address - Country:US
Practice Address - Phone:914-419-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health