Individual
JOHN HENNESSY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
84 TALLOW WOOD DR, CLIFTON PARK, NY 12065-2827
(518) 817-7216
Mailing address
84 TALLOW WOOD DR, CLIFTON PARK, NY 12065-2827
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
96125
NY
Other
Enumeration date
04/28/2015
Last updated
04/28/2015
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