Provider Demographics
NPI:1164838348
Name:CUDDY, CASEY (PMHNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CUDDY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:WILBUR
Other - Middle Name:
Other - Last Name:CUDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:621 ROUTE 52 # 2F
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1235
Mailing Address - Country:US
Mailing Address - Phone:646-875-8659
Mailing Address - Fax:646-354-7659
Practice Address - Street 1:621 ROUTE 52 # 2F
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1235
Practice Address - Country:US
Practice Address - Phone:646-875-8659
Practice Address - Fax:646-354-7659
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402368363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty