Healthcare Provider Details

I. General information

NPI: 1679873020
Provider Name (Legal Business Name): RAY V. FACEY CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 JOHN ST 27 TH FL
NEW YORK NY
10038-3300
US

IV. Provider business mailing address

116 JOHN ST 27 TH FL
NEW YORK NY
10038-3300
US

V. Phone/Fax

Practice location:
  • Phone: 212-964-0128
  • Fax: 212-964-0112
Mailing address:
  • Phone: 212-964-0128
  • Fax: 212-964-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18900
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: