Healthcare Provider Details

I. General information

NPI: 1851709653
Provider Name (Legal Business Name): RAFAEL ANTONIO SANCHEZ CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 OLD ROUTE 6
CARMEL NY
10512-2107
US

IV. Provider business mailing address

37 JEFFERSON AVE
DANBURY CT
06810-7913
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: