Healthcare Provider Details

I. General information

NPI: 1255732939
Provider Name (Legal Business Name): LORRAINE CARROLL CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 09/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARPENTER PL
MONROE NY
10950-3515
US

IV. Provider business mailing address

101 CARPENTER PL
MONROE NY
10950-3515
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-0295
  • Fax: 845-782-5164
Mailing address:
  • Phone: 845-782-0295
  • Fax: 845-782-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: