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General NPI Number Information
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NPI Number | 1619805579
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Entity Type | Individual
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Provider Name | ROGER PERRY COX JR. CASAC 2
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Gender | Male
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 139 N MAIN ST
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City | CORTLAND
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State | NY
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Zip | 13045-1226
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Country | US
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Telephone | 607-756-4167
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Fax |
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Provider Business Mailing Address
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Address Line | 28 STATE ST
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City | TULLY
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State | NY
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Zip | 13159-3254
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Country | US
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Telephone | 843-610-1408
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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 | CASAC-39617
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License Number State | NY
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