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General NPI Number Information
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NPI Number | 1982064416
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Entity Type | Individual
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Provider Name | CONCEPCION PACHECO CASAC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 420 DOUGHTY BLVD
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City | INWOOD
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State | NY
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Zip | 11096-1357
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Country | US
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Telephone | 516-564-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CEDAR ST APT 207
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City | FORT LEE
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State | NJ
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Zip | 07024-7037
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Country | US
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Telephone | 718-496-1589
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6469
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6469
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License Number State | NY
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