Healthcare Provider Details

I. General information

NPI: 1275602609
Provider Name (Legal Business Name): ASHLEY L POLLOCK CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2925 HAMBURG ST BOX 3
SCHENECTADY NY
12303-4343
US

IV. Provider business mailing address

60 PHILIP ST BASEMENT
ALBANY NY
12202-1729
US

V. Phone/Fax

Practice location:
  • Phone: 518-357-2909
  • Fax: 518-357-2937
Mailing address:
  • Phone: 518-357-2909
  • Fax: 518-357-2937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18964
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: