Charles Moak, CASAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

3689 Issued in NY

Practice address

55 Elm St
Glens Falls, NY 12801-3549

Phone

(518) 793-7273

Fax

(518) 798-5004

NPI assigned

Apr 2, 2012

Last updated

Nov 20, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Liverpool, NY
  • NPI 1366498768
  NPD (past)
• Conifer Park, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Glens Falls, NY
  • NPI 1972558179
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1942566179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 TALLOW WOOD CT",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120652806",
            "telephone_number": "518-369-6962",
            "fax_number": "518-952-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ELM ST",
            "city": "GLENS FALLS",
            "state": "NY",
            "postal_code": "128013549",
            "telephone_number": "518-793-7273",
            "fax_number": "518-798-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOAK",
        "first_name": "CHARLES",
        "credential": "CASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "3689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Travis Minzloff, DO
• Richard P. Miraglia, LCSW
• Carrie B Miron, PA-C
• Jamie Patricia Misner, SLP
• Jo Anne Mitchum
• Todd Monahan
• Stephen Anthony Monn, MD
• Kathleen Marie Monroe, RD CDN
• Kaitlyn Montgomery, PA-C
• Susan E Moore, MD FAAP

• Addiction (Substance Use Disorder) Counselor in Glens Falls, NY
• Providers in Glens Falls, NY by specialty
• Addiction (Substance Use Disorder) Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.