Healthcare Provider Details

I. General information

NPI: 1558873091
Provider Name (Legal Business Name): AMANDA L YANNARELLI CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 09/11/2025
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORPORATE DR
PEEKSKILL NY
10566-1846
US

IV. Provider business mailing address

37 PUGSLEY PKWY
CORTLANDT MANOR NY
10567-1007
US

V. Phone/Fax

Practice location:
  • Phone: 914-257-3500
  • Fax: 914-737-2508
Mailing address:
  • Phone: 914-729-4940
  • Fax: 914-737-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: