Healthcare Provider Details

I. General information

NPI: 1760602825
Provider Name (Legal Business Name): CAROLYN LLOUISE MARCHILLO CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 GEYSER ROAD
BALLSTON SPA NY
12020
US

IV. Provider business mailing address

39 KNOLLWOOD DR
SARATOGA SPRINGS NY
12866-5775
US

V. Phone/Fax

Practice location:
  • Phone: 518-885-6884
  • Fax: 518-885-0077
Mailing address:
  • Phone: 518-587-5833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: