Provider Demographics
NPI:1487339057
Name:MARTABANO, WHITNEY E (CASAC-T)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:MARTABANO
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-2830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 PAGE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7500
Practice Address - Country:US
Practice Address - Phone:845-486-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37417101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)