Healthcare Provider Details

I. General information

NPI: 1700357159
Provider Name (Legal Business Name): CARIN MARIE KLINGER CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE STE 300
HEMPSTEAD NY
11550-3702
US

IV. Provider business mailing address

68 HEWLETT POINT AVE
EAST ROCKAWAY NY
11518-2424
US

V. Phone/Fax

Practice location:
  • Phone: 516-481-0052
  • Fax:
Mailing address:
  • Phone: 516-426-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: