Provider Demographics
NPI:1255859096
Name:PFEIFFER, KENNETH (CASAC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:PFEIFFER
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 1:198 BEACH 102ND ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2853
Mailing Address - Country:US
Mailing Address - Phone:347-205-1780
Mailing Address - Fax:
Practice Address - Street 1:830 FOREST AVE RM 139
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7802
Practice Address - Country:US
Practice Address - Phone:718-742-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18708101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)