Healthcare Provider Details

I. General information

NPI: 1235053257
Provider Name (Legal Business Name): VAN ALLEN E THOMAS CASAC2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E WATER ST
SYRACUSE NY
13202-1123
US

IV. Provider business mailing address

400 SOUTH AVE
SOLVAY NY
13209-2448
US

V. Phone/Fax

Practice location:
  • Phone: 315-475-1771
  • Fax:
Mailing address:
  • Phone: 315-807-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: