MEDICARE: MR. JASON GORENSTEIN CASAC-T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	40518	NY

General Provider Information

NPI Number	:	1043155898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON GORENSTEIN CASAC-T

Provider Business Mailing Address
First Line	:	3404 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4436
Country	:	US
Telephone Number	:	212-627-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4436
Country	:	US
Telephone Number	:	212-627-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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