Provider Demographics
NPI:1790470078
Name:SINGLETARY, SAMUEL III (CASAC-T)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:SINGLETARY
Suffix:III
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 1:24 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2814
Mailing Address - Country:US
Mailing Address - Phone:914-666-6740
Mailing Address - Fax:914-666-8596
Practice Address - Street 1:24 SMITH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2814
Practice Address - Country:US
Practice Address - Phone:914-666-6740
Practice Address - Fax:914-666-8596
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38595101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)