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General NPI Number Information
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NPI Number | 1689234668
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Entity Type | Individual
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Provider Name | HEIDI LYNNE KAZMARK CASAC-T
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Gender | Female
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 36 THOMAS INDIAN SCHOOL DR
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City | IRVING
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State | NY
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Zip | 14081-9300
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Country | US
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Telephone | 716-532-8223
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Fax |
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Provider Business Mailing Address
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Address Line | 7919 MILL STREET
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City | EAST OTTO
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State | NY
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Zip | 14729
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Country | US
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Telephone | 716-244-1854
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Fax | 716-242-1663
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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 | 35657
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License Number State | NY
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