Provider Demographics
NPI:1851074447
Name:MCCRAY SLUSSER, KIMBERLY D (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:MCCRAY SLUSSER
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:MCCLAY SLUSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PEER SUPPORT SPECIAL
Mailing Address - Street 1:16039 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:CONSTABLE
Mailing Address - State:NY
Mailing Address - Zip Code:12926-2704
Mailing Address - Country:US
Mailing Address - Phone:518-714-3195
Mailing Address - Fax:
Practice Address - Street 1:125 FINNEY BLVD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1067
Practice Address - Country:US
Practice Address - Phone:518-481-8160
Practice Address - Fax:518-483-0878
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
NY175T00000X175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist