Provider Demographics
NPI:1427409119
Name:CABALLERO, YASU (NYS CASAC)
Entity Type:Individual
Prefix:MR
First Name:YASU
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:M
Credentials:NYS CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1824
Mailing Address - Country:US
Mailing Address - Phone:845-856-7576
Mailing Address - Fax:
Practice Address - Street 1:123 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1824
Practice Address - Country:US
Practice Address - Phone:845-856-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25298101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25298OtherNYS OFFICE OF ALCOHOLISM AND SUBSTANCE ABUSE SERVICES