Healthcare Provider Details

I. General information

NPI: 1083521926
Provider Name (Legal Business Name): RYAN CASEY MHC-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W BAY PLZ
PLATTSBURGH NY
12901-1786
US

IV. Provider business mailing address

15 COURT ST APT 2
PLATTSBURGH NY
12901-2909
US

V. Phone/Fax

Practice location:
  • Phone: 518-593-7602
  • Fax:
Mailing address:
  • Phone: 518-420-2566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP132931
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: