MEDICARE: MRS. DENNISE EWEN CASAC; LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	18012	NY
2	104100000X	Social Worker	72089242	NY

General Provider Information

NPI Number	:	1033357959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DENNISE EWEN CASAC; LMSW

Provider Business Mailing Address
First Line	:	3368 BAYCHESTER AVE # 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-1514
Country	:	US
Telephone Number	:	347-847-2161
Fax Number	:

Provider Business Practice Location Address
First Line	:	3368 BAYCHESTER AVE # 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-1514
Country	:	US
Telephone Number	:	347-847-2161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	05/01/2014

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