Provider Demographics
NPI:1932224037
Name:OLIVERAS, CARL JOHN (CASAC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:JOHN
Last Name:OLIVERAS
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 1:106 VINEYARD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1422
Mailing Address - Country:US
Mailing Address - Phone:845-691-9191
Mailing Address - Fax:845-691-9339
Practice Address - Street 1:106 VINEYARD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1422
Practice Address - Country:US
Practice Address - Phone:845-691-9191
Practice Address - Fax:845-691-9339
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11539101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)