MEDICARE: MITCHELL B BARR 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	CASAC-24761	NY

General Provider Information

NPI Number	:	1104375658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL B BARR CASAC

Provider Business Mailing Address
First Line	:	39 ROME AVE
Second Line	:	APT. 12B
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-2328
Country	:	US
Telephone Number	:	914-299-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 ROME AVE
Second Line	:	APT. 12B
City	:	BEDFORD HILLS
State	:	NY
Zip	:	10507-2328
Country	:	US
Telephone Number	:	914-299-7827
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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