Provider Demographics
NPI:1295820512
Name:OCLATIS, KENNETH A (PHD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:A
Last Name:OCLATIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 N PARSONAGE ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1221
Mailing Address - Country:US
Mailing Address - Phone:845-876-7349
Mailing Address - Fax:845-876-1342
Practice Address - Street 1:9 VASSAR ST
Practice Address - Street 2:STE 35
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3022
Practice Address - Country:US
Practice Address - Phone:845-389-1475
Practice Address - Fax:845-876-1342
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005723-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical