Healthcare Provider Details

I. General information

NPI: 1174096564
Provider Name (Legal Business Name): ZOIE BECK CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 STRINGHAM RD APT 7F
LAGRANGEVILLE NY
12540-5506
US

IV. Provider business mailing address

136 STRINGHAM RD APT 7F
LAGRANGEVILLE NY
12540-5506
US

V. Phone/Fax

Practice location:
  • Phone: 845-225-5202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: