Healthcare Provider Details

I. General information

NPI: 1033567029
Provider Name (Legal Business Name): BARBARA TABALA CASAC-G
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 59 SUITE 117
AIRMONT NY
10901-4927
US

IV. Provider business mailing address

101 GEDNEY ST APT 6G
NYACK NY
10960-2237
US

V. Phone/Fax

Practice location:
  • Phone: 845-369-9701
  • Fax: 845-369-9704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2353
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: