Healthcare Provider Details

I. General information

NPI: 1679651897
Provider Name (Legal Business Name): LORETTA A. SPRAGUE CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 COUNTY COMPLEX DR
CANANDAIGUA NY
14424-9505
US

IV. Provider business mailing address

3149 E CEDARBUSH DR
CANANDAIGUA NY
14424-1700
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-4190
  • Fax: 585-393-2916
Mailing address:
  • Phone: 585-393-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: