MEDICARE: MR. ANTHONY MCFADDEN C.A.S.A.C

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	27585	NY

General Provider Information

NPI Number	:	1477009124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY MCFADDEN C.A.S.A.C

Provider Business Mailing Address
First Line	:	625 WEST 140TH STREET
Second Line	:
City	:	MANHATTAN
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	646-937-5325
Fax Number	:	212-537-5594

Provider Business Practice Location Address
First Line	:	625 WEST 140TH STREET
Second Line	:
City	:	MANHATTAN
State	:	NY
Zip	:	10031
Country	:	US
Telephone Number	:	646-937-5325
Fax Number	:	212-537-5594

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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