Healthcare Provider Details

I. General information

NPI: 1821979121
Provider Name (Legal Business Name): ELIZABETH REEVES CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROUTE 59 STE 111
AIRMONT NY
10901-4927
US

IV. Provider business mailing address

100 ROUTE 59 STE 111
AIRMONT NY
10901-4927
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number31782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: