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NPI Code Detail

MEDICARE: LISA CHRISTINE VICENTE CASAC-T

MEDICARE:   LISA CHRISTINE VICENTE  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
1101YA0400XAddiction (Substance Use Disorder) Counselor29072NY

General Provider Information

NPI Number : 1376903484
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA CHRISTINE VICENTE CASAC-T
Provider Business Mailing Address
First Line : 435 E 119TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3627
Country : US
Telephone Number : 212-360-4002
Fax Number : 212-360-4012
Provider Business Practice Location Address
First Line : 435 E 119TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3627
Country : US
Telephone Number : 212-360-4002
Fax Number : 212-360-4012
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2016
Last Update Date : 03/02/2016

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Directions to “ LISA CHRISTINE VICENTE CASAC-T” Practice Location

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