Provider Demographics
NPI:1558178780
Name:MESCALL, KEVIN G
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:G
Last Name:MESCALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 POND PL
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1420
Mailing Address - Country:US
Mailing Address - Phone:631-942-2743
Mailing Address - Fax:
Practice Address - Street 1:40 POND PL
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1420
Practice Address - Country:US
Practice Address - Phone:631-942-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)