Healthcare Provider Details

I. General information

NPI: 1316635550
Provider Name (Legal Business Name): LANCE SCHEFFER ALEXANDER CASAC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 WARBURTON AVE APT 516
YONKERS NY
10701-1013
US

IV. Provider business mailing address

24 SMITH AVE
MOUNT KISCO NY
10549-2814
US

V. Phone/Fax

Practice location:
  • Phone: 917-535-6276
  • Fax:
Mailing address:
  • Phone: 914-666-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: