Healthcare Provider Details

I. General information

NPI: 1497074892
Provider Name (Legal Business Name): MELISSA A QUICK CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST
CORTLAND NY
13045
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3049
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-0234
  • Fax: 607-753-0286
Mailing address:
  • Phone: 607-753-0234
  • Fax: 607-753-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19321
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: