Healthcare Provider Details

I. General information

NPI: 1497103477
Provider Name (Legal Business Name): ALMA DEROSA CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 PAGE PARK DR
POUGHKEEPSIE NY
12603-7500
US

IV. Provider business mailing address

41 PAGE PARK DR
POUGHKEEPSIE NY
12603-7500
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-2950
  • Fax: 845-486-2999
Mailing address:
  • Phone: 845-486-2950
  • Fax: 845-486-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22229
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: