Healthcare Provider Details

I. General information

NPI: 1114754371
Provider Name (Legal Business Name): MARGARET POZIOMSKA MASTER CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 BROADWAY
MONTICELLO NY
12701-1157
US

IV. Provider business mailing address

617 KATRINA FALLS RD
ROCK HILL NY
12775-6055
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax:
Mailing address:
  • Phone: 845-798-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: