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General NPI Number Information
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NPI Number | 1639083876
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Entity Type | Individual
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Provider Name | COREY ROGERS CASAC 2
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Gender | Male
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 250 COOPER AVE
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City | TONAWANDA
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State | NY
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Zip | 14150-6633
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Country | US
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Telephone | 716-218-4143
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Fax |
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Provider Business Mailing Address
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Address Line | 269 MORGAN ST UPPR
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City | TONAWANDA
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State | NY
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Zip | 14150-2041
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Country | US
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Telephone | 716-352-8616
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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 | 42342
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NY
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