Healthcare Provider Details

I. General information

NPI: 1477835650
Provider Name (Legal Business Name): MICHAEL P OBRIEN CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34570 STATE HIGHWAY 10 SUITE 5
HAMDEN NY
13782-1120
US

IV. Provider business mailing address

18 PLATT ST APT 5
WALTON NY
13856-1353
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-7656
  • Fax: 607-865-7659
Mailing address:
  • Phone: 607-206-3287
  • Fax: 607-865-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: