Healthcare Provider Details

I. General information

NPI: 1710652524
Provider Name (Legal Business Name): MONICA STARR LARKIN CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

IV. Provider business mailing address

81 LAKE AVE
ROCHESTER NY
14608-1410
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6938
  • Fax: 585-723-7301
Mailing address:
  • Phone: 585-368-6938
  • Fax: 585-723-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number40902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: