Healthcare Provider Details

I. General information

NPI: 1043140460
Provider Name (Legal Business Name): CRYSTAL L DINSMORE CASAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 E MAIN ST
ROCHESTER NY
14609-7448
US

IV. Provider business mailing address

1869 E MAIN ST
ROCHESTER NY
14609-7448
US

V. Phone/Fax

Practice location:
  • Phone: 585-775-3625
  • Fax:
Mailing address:
  • Phone: 585-775-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: