Basic Information
| Provider Information | |||||||||
| NPI: | 1114441235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COSSENTINO | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CASAC-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 ELLSWORTH LN | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126012869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453724537 | ||||||||
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| Practice Location | |||||||||
| Address1: | 280 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455628255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.