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NPI Code Detail

MEDICARE: MYRON MYCHAJLUK CASAC

MEDICARE: MYRON MYCHAJLUK 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
1101YA0400XAddiction (Substance Use Disorder) Counselor8568NY

General Provider Information

NPI Number : 1437210283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRON MYCHAJLUK CASAC
Provider Business Mailing Address
First Line : 227 THORN AVE
Second Line : SPECTRUM HUMAN SERVICES
City : ORCHARD PARK
State : NY
Zip : 14127-2600
Country : US
Telephone Number : 716-662-2040
Fax Number : 716-662-0019
Provider Business Practice Location Address
First Line : 2040 SENECA ST
Second Line : SOUTH BUFFALO COUNSELING CENTER
City : BUFFALO
State : NY
Zip : 14210-2324
Country : US
Telephone Number : 716-828-0560
Fax Number : 716-828-1522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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