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General NPI Number Information
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NPI Number | 1265853493
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Entity Type | Individual
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Provider Name | ERROLL SAM CASAC
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Gender | Male
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 380 NASSAU RD
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City | ROOSEVELT
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State | NY
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Zip | 11575-1343
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Country | US
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Telephone | 516-623-7741
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Fax | 516-623-7775
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Provider Business Mailing Address
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Address Line | 102 COOLIDGE AVE
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City | AMITYVILLE
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State | NY
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Zip | 11701-2453
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Country | US
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Telephone | 516-623-7741
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Fax | 516-623-7775
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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 | 18871
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License Number State | NY
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