Provider Demographics
NPI:1366037145
Name:MANCUSI, DENNIS DANIEL (CASAC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DANIEL
Last Name:MANCUSI
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COMMERCIAL PL
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5306
Mailing Address - Country:US
Mailing Address - Phone:845-220-2146
Mailing Address - Fax:845-561-3913
Practice Address - Street 1:3 COMMERCIAL PL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5306
Practice Address - Country:US
Practice Address - Phone:845-220-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31004101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)