MEDICARE: PATRICIA DENHAM CASAC

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	11880	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11880	OTHER	NY	CASAC

General Provider Information

NPI Number	:	1043741036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DENHAM CASAC

Provider Business Mailing Address
First Line	:	27 STRATHALLAN PARK APT 6
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14607-1541
Country	:	US
Telephone Number	:	585-546-1271
Fax Number	:	585-546-2607

Provider Business Practice Location Address
First Line	:	55 TROUP ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-2053
Country	:	US
Telephone Number	:	585-546-1271
Fax Number	:	585-546-2607

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	03/22/2017

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