Healthcare Provider Details

I. General information

NPI: 1023869468
Provider Name (Legal Business Name): MARSHA L WILCOX CASAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WHITESBORO ST
UTICA NY
13502-3015
US

IV. Provider business mailing address

500 WHITESBORO ST
UTICA NY
13502-3015
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-5168
  • Fax: 315-724-6582
Mailing address:
  • Phone: 315-724-5168
  • Fax: 315-724-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: