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General NPI Number Information
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NPI Number | 1023387016
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Entity Type | Individual
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Provider Name | ANNA DEC CASAC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 6801 FRESH POND RD APT.2F
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5233
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Country | US
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Telephone | 917-600-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 FRESH POND RD APT.2F
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5233
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Country | US
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Telephone | 17-600-2158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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