Healthcare Provider Details

I. General information

NPI: 1265839237
Provider Name (Legal Business Name): PAMELA FORTE CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 STATE ST
PERTH AMBOY NJ
08861-4348
US

IV. Provider business mailing address

262 STATE ST
PERTH AMBOY NJ
08861-4348
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-3535
  • Fax:
Mailing address:
  • Phone: 732-442-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: