Provider Demographics
NPI:1437791886
Name:OLMEDO, JOSEPH (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:OLMEDO
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 PHELPS LANE - ANNEX BUILDING
Mailing Address - Street 2:DRUG & ALCOHOL SERVICES
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4005
Mailing Address - Country:US
Mailing Address - Phone:631-422-7676
Mailing Address - Fax:631-422-7609
Practice Address - Street 1:281 PHELPS LANE - ANNEX BUILDING
Practice Address - Street 2:DRUG & ALCOHOL SERVICES
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4005
Practice Address - Country:US
Practice Address - Phone:631-422-7676
Practice Address - Fax:631-422-7609
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty