Healthcare Provider Details

I. General information

NPI: 1912721721
Provider Name (Legal Business Name): BRANDON MICHAEL SANDERS CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORPORATE DR
PEEKSKILL NY
10566-1810
US

IV. Provider business mailing address

667 BRANDT AVE
PEEKSKILL NY
10566-2315
US

V. Phone/Fax

Practice location:
  • Phone: 914-257-3500
  • Fax:
Mailing address:
  • Phone: 646-698-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number38128
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: