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NPI Code Detail

MEDICARE: MS. CONSTANCE DIANE PENTONY-BROWN CASAC-G

MEDICARE: MS. CONSTANCE DIANE PENTONY-BROWN CASAC-G
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) CounselorCASAC-10898NY

General Provider Information

NPI Number : 1417215617
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CONSTANCE DIANE PENTONY-BROWN CASAC-G
Provider Business Mailing Address
First Line : 449 39TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-2909
Country : US
Telephone Number : 718-871-2400
Fax Number : 718-871-6431
Provider Business Practice Location Address
First Line : 449 39TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-2909
Country : US
Telephone Number : 718-871-2400
Fax Number : 718-871-6431
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2012
Last Update Date : 05/05/2020

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1457609588 — MR. PAUL ALVES CASAC-T
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1588074512 — DELORES ANDERSON LPN
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1396155313 — DAISY MORALES CASAC-T
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449 39TH ST
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