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General NPI Number Information
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NPI Number | 1851149280
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Entity Type | Individual
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Provider Name | TENNILLE BURMAN CASAC 2
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Gender | Female
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Dates
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Enumeration Date | 05/09/2024
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 69 SECOND AVE
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-2409
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Country | US
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Telephone | 518-844-3184
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Fax |
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Provider Business Mailing Address
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Address Line | 770 GRAND BLVD STE 17
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City | DEER PARK
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State | NY
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Zip | 11729-5725
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Country | US
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Telephone | 631-392-0435
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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 |
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License Number State |
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