Provider Demographics
NPI:1952615668
Name:ESCHENBERT, KATHLEEN FRANCES (CASAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:ESCHENBERT
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUSSEX ST # 19
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-2430
Mailing Address - Country:US
Mailing Address - Phone:845-856-6344
Mailing Address - Fax:845-856-4091
Practice Address - Street 1:17 SUSSEX ST # 19
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-2430
Practice Address - Country:US
Practice Address - Phone:845-856-6344
Practice Address - Fax:845-856-4091
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22806101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)