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General NPI Number Information
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NPI Number | 1104351733
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Entity Type | Individual
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Provider Name | MICHAEL CASARICO
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Gender | Male
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 184 KING ST
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City | BURLINGTON
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State | VT
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Zip | 05401-4534
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Country | US
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Telephone | 802-503-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 274 SPINNAKER LN
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City | SHELBURNE
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State | VT
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Zip | 05482-7783
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Country | US
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Telephone | 802-503-5450
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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 | 151.0127615
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License Number State | VT
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