Healthcare Provider Details

I. General information

NPI: 1598961880
Provider Name (Legal Business Name): ERIC LESLIE HUTCHINSON C.A.S.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17919 SELOVER RD
JAMAICA NY
11434-3409
US

IV. Provider business mailing address

17919 SELOVER RD
JAMAICA NY
11434-3409
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-1951
  • Fax:
Mailing address:
  • Phone: 718-978-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCASAC-20049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: