Provider Demographics
NPI:1972735421
Name:HINTON, GARRY LEE (CASAC)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:LEE
Last Name:HINTON
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5408
Mailing Address - Country:US
Mailing Address - Phone:845-562-8255
Mailing Address - Fax:
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-562-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18260101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)