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General NPI Number Information
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NPI Number | 1558466789
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Entity Type | Individual
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Provider Name | CARL RENE GYSEL CASAC
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 FORT HILL AVE 6A
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1159
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Country | US
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Telephone | 585-393-7701
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Fax | 585-393-8344
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Provider Business Mailing Address
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Address Line | 293 N PEARL ST
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City | CANANDAIGUA
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State | NY
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Zip | 14424-1432
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Country | US
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Telephone | 585-393-7701
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Fax | 585-393-8344
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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 | 11206
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License Number State | NY
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