Healthcare Provider Details

I. General information

NPI: 1043136971
Provider Name (Legal Business Name): ERIN BOND CASAC- T 40177
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ERIE BLVD W STE 302
SYRACUSE NY
13204-2463
US

IV. Provider business mailing address

111 N DIVISION ST
AUBURN NY
13021-1706
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7363
  • Fax: 315-472-0084
Mailing address:
  • Phone: 315-472-7363
  • Fax: 315-472-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number40177
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: