=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992820872
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN FRANQUIZ CASAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9729 64TH RD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-2240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-896-3400
-----------------------------------------------------
Fax | 718-459-5621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 970 HEMPSTEAD AVE
-----------------------------------------------------
City | WEST HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11552-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-896-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 4227
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------