Healthcare Provider Details

I. General information

NPI: 1235922071
Provider Name (Legal Business Name): MAKENZIE STORTO CASAC -T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 NYE RD
LYONS NY
14489-9133
US

IV. Provider business mailing address

2880 MACEDON CENTER RD LOT 132880
PALMYRA NY
14522-9310
US

V. Phone/Fax

Practice location:
  • Phone: 315-946-5722
  • Fax:
Mailing address:
  • Phone: 315-690-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: