Provider Demographics
NPI:1972228898
Name:BRENDLER, BEAU H (CASAC-T, CARC)
Entity Type:Individual
Prefix:
First Name:BEAU
Middle Name:H
Last Name:BRENDLER
Suffix:
Gender:M
Credentials:CASAC-T, CARC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PAGE PARK DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-7500
Mailing Address - Country:US
Mailing Address - Phone:845-486-2950
Mailing Address - Fax:
Practice Address - Street 1:7 DOVER VILLAGE PLAZA, STE #2
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522
Practice Address - Country:US
Practice Address - Phone:845-444-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36643101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12345Medicaid