Provider Demographics
NPI:1164857942
Name:KUEHNEL-HISATAKE, GAY (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:GAY
Middle Name:
Last Name:KUEHNEL-HISATAKE
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SAMSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2649
Mailing Address - Country:US
Mailing Address - Phone:845-626-5332
Mailing Address - Fax:
Practice Address - Street 1:50 CENTER ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1315
Practice Address - Country:US
Practice Address - Phone:845-647-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO211591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical