Provider Demographics
NPI:1164838348
Name:CUDDY, CASEY (PMHNP-C)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:CUDDY
Suffix:
Gender:M
Credentials:PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ROMBOUT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3209
Mailing Address - Country:US
Mailing Address - Phone:646-801-6246
Mailing Address - Fax:
Practice Address - Street 1:86 ROMBOUT AVE # 1
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3209
Practice Address - Country:US
Practice Address - Phone:646-801-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402368363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty