Provider Demographics
NPI:1235773862
Name:HOPE, KEVIN ROGER (MA, ED,S, LMHC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROGER
Last Name:HOPE
Suffix:
Gender:M
Credentials:MA, ED,S, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:CONKLIN
Mailing Address - State:NY
Mailing Address - Zip Code:13748-0001
Mailing Address - Country:US
Mailing Address - Phone:607-235-3101
Mailing Address - Fax:607-235-3101
Practice Address - Street 1:1355 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795-1640
Practice Address - Country:US
Practice Address - Phone:607-222-8032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health