Healthcare Provider Details

I. General information

NPI: 1831765890
Provider Name (Legal Business Name): SEAN J. DEDIER CASAC ADVANCED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 CLAY AVE
BRONX NY
10457-7299
US

IV. Provider business mailing address

1776 CLAY AVE
BRONX NY
10457-7299
US

V. Phone/Fax

Practice location:
  • Phone: 347-649-3275
  • Fax:
Mailing address:
  • Phone: 347-649-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number32656
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number32656
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: