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NPI Code Detail

MEDICARE: MR. FRANK RUFFLEY MULLINEUX CASAC MASTERS

MEDICARE: MR. FRANK RUFFLEY MULLINEUX CASAC MASTERS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor13216NY

General Provider Information

NPI Number : 1306123633
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FRANK RUFFLEY MULLINEUX CASAC MASTERS
Provider Business Mailing Address
First Line : 1268 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-2312
Country : US
Telephone Number : 718-981-8117
Fax Number : 718-981-9344
Provider Business Practice Location Address
First Line : 1268 FOREST AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10302-2312
Country : US
Telephone Number : 718-981-8117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2011
Last Update Date : 09/30/2024

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