Healthcare Provider Details

I. General information

NPI: 1821324799
Provider Name (Legal Business Name): YANIQUE BRITTON CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

IV. Provider business mailing address

224 ALEXANDER ST
ROCHESTER NY
14607-4000
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-7230
  • Fax: 585-922-7225
Mailing address:
  • Phone: 585-922-7230
  • Fax: 585-922-7225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: