Provider Demographics
NPI:1841493269
Name:NIAL, KEVIN J (CPP, CASAC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:NIAL
Suffix:
Gender:M
Credentials:CPP, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MORGAN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-3324
Mailing Address - Country:US
Mailing Address - Phone:607-334-2429
Mailing Address - Fax:
Practice Address - Street 1:105 LEILANIS LN
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-3540
Practice Address - Country:US
Practice Address - Phone:607-337-1680
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253101Y00000X
NY11582101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)