Healthcare Provider Details

I. General information

NPI: 1952620379
Provider Name (Legal Business Name): RENEE SYLVESTER CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HAMILTON AVE
MONTICELLO NY
12701-1319
US

IV. Provider business mailing address

443 SACKETT LAKE RD
MONTICELLO NY
12701-4467
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-8080
  • Fax: 845-794-8343
Mailing address:
  • Phone: 845-796-8589
  • 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: