Healthcare Provider Details

I. General information

NPI: 1780520064
Provider Name (Legal Business Name): CARLOS PEREZ CASAC2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CHAPEL ST STE 701
BROOKLYN NY
11201-1917
US

IV. Provider business mailing address

2024 BENEDICT AVE APT 6F
BRONX NY
10462-4429
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-9658
  • Fax: 718-858-9670
Mailing address:
  • Phone: 718-858-9658
  • Fax: 718-858-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: