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General NPI Number Information
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NPI Number | 1063364222
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Entity Type | Individual
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Provider Name | THADDIUS A KING CASAC T 41385
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Gender | Male
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 400 CROOKED HILL RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-1039
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Country | US
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Telephone | 631-231-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 526 GREENGROVE AVE
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City | UNIONDALE
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State | NY
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Zip | 11553-2145
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Country | US
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Telephone | 516-729-2324
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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 | CASACT41385
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License Number State | NY
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