Healthcare Provider Details

I. General information

NPI: 1912426594
Provider Name (Legal Business Name): CURTIS EVANS CASAC-G/CPP-G
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 HILLSIDE AVE STE 2
JAMAICA NY
11432-5732
US

IV. Provider business mailing address

704 N BROADWAY
YONKERS NY
10701-1712
US

V. Phone/Fax

Practice location:
  • Phone: 347-210-2943
  • Fax: 718-558-7230
Mailing address:
  • Phone: 347-210-2943
  • Fax: 718-658-5913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number706
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: