Healthcare Provider Details

I. General information

NPI: 1114090180
Provider Name (Legal Business Name): PATRICIA L PASCULLE CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 INDUCON DR E
SANBORN NY
14132-9014
US

IV. Provider business mailing address

6301 INDUCON DR E
SANBORN NY
14132-9014
US

V. Phone/Fax

Practice location:
  • Phone: 716-731-2030
  • Fax: 716-731-3010
Mailing address:
  • Phone: 716-731-2030
  • Fax: 716-731-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: