Healthcare Provider Details

I. General information

NPI: 1871077412
Provider Name (Legal Business Name): DEBRA LYNN MARSHALL CASAC-T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 COURT ST STE 210
UTICA NY
13502-4233
US

IV. Provider business mailing address

13 BEAVER ST
DOLGEVILLE NY
13329-1226
US

V. Phone/Fax

Practice location:
  • Phone: 315-507-5800
  • Fax: 315-507-5802
Mailing address:
  • Phone: 315-765-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: