Healthcare Provider Details

I. General information

NPI: 1225871536
Provider Name (Legal Business Name): CAITLIN LUSK CRPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S SALINA STREET ATTN: CAPS DEPARTMENT
SYRACUSE NY
13202-3570
US

IV. Provider business mailing address

819 S SALINA STREET ATTN: CAPS DEPARTMENT
SYRACUSE NY
13202-3570
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-7921
  • Fax: 315-428-8843
Mailing address:
  • Phone: 315-476-7921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number41829
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-5534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: