Healthcare Provider Details

I. General information

NPI: 1295034411
Provider Name (Legal Business Name): RICHARD MARTHALLER CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 UNIVERSITY AVE SUITE 7
ROCHESTER NY
14607-1647
US

IV. Provider business mailing address

1150 UNIVERSITY AVE SUITE 7
ROCHESTER NY
14607-1647
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-8422
  • Fax: 585-442-8494
Mailing address:
  • Phone: 585-442-8422
  • Fax: 585-442-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: