Provider Demographics
NPI:1447554704
Name:POCILUYKO, PETER J (CASAC)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:J
Last Name:POCILUYKO
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 REMSEN ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2605
Mailing Address - Country:US
Mailing Address - Phone:518-235-1100
Mailing Address - Fax:518-235-0079
Practice Address - Street 1:50 REMSEN ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2605
Practice Address - Country:US
Practice Address - Phone:518-235-1100
Practice Address - Fax:518-235-0079
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11566101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)