Healthcare Provider Details

I. General information

NPI: 1902310303
Provider Name (Legal Business Name): ARTHUR CONNOR CASAC 2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 CLINTON AVE S
ROCHESTER NY
14620-1105
US

IV. Provider business mailing address

22 SUTTERS RUN
ROCHESTER NY
14624-3757
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: