Provider Demographics
NPI:1053953570
Name:JODIN, TINA M (CASAC T)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:JODIN
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 1:77 MERILINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW WINSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-728-2586
Mailing Address - Fax:
Practice Address - Street 1:CATHOLIC CHARITIES
Practice Address - Street 2:27 MATTHEWS ST.
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-294-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)