Healthcare Provider Details

I. General information

NPI: 1558927541
Provider Name (Legal Business Name): HENRY WUERZ CASAC 2
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 ROUTE 376
WAPPINGERS FALLS NY
12590-6483
US

IV. Provider business mailing address

942 ROUTE 376
WAPPINGERS FALLS NY
12590-6483
US

V. Phone/Fax

Practice location:
  • Phone: 845-765-2366
  • Fax:
Mailing address:
  • Phone: 845-765-2366
  • 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: