Provider Demographics
NPI:1811798671
Name:MCNEIL, KIMM SHELLEY (CASAS 2)
Entity type:Individual
Prefix:
First Name:KIMM
Middle Name:SHELLEY
Last Name:MCNEIL
Suffix:
Gender:
Credentials:CASAS 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HEMLOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4903
Mailing Address - Country:US
Mailing Address - Phone:914-589-6084
Mailing Address - Fax:
Practice Address - Street 1:3 CORPORATE DR # 3H
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-1846
Practice Address - Country:US
Practice Address - Phone:914-257-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5890101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)