MEDICARE: ANDREA M. IRIZARRY 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1477635654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA M. IRIZARRY CASAC

Provider Business Mailing Address
First Line	:	PO BOX 631
Second Line	:
City	:	ORCHARD PARK
State	:	NY
Zip	:	14127-0631
Country	:	US
Telephone Number	:	716-662-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1280 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14209-1912
Country	:	US
Telephone Number	:	716-832-1251
Fax Number	:	716-832-1271

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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