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NPI Code Detail

MEDICARE: JUSTIN SCOTT HERBEL CASAC

MEDICARE: JUSTIN SCOTT HERBEL 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) Counselor25178NY

General Provider Information

NPI Number : 1477961175
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN SCOTT HERBEL CASAC
Provider Business Mailing Address
First Line : 380 FREEVILLE RD
Second Line :
City : FREEVILLE
State : NY
Zip : 13068-9684
Country : US
Telephone Number : 607-844-6490
Fax Number :
Provider Business Practice Location Address
First Line : 380 FREEVILLE RD
Second Line :
City : FREEVILLE
State : NY
Zip : 13068-9684
Country : US
Telephone Number : 607-844-6490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2014
Last Update Date : 07/25/2014

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Directions to “ JUSTIN SCOTT HERBEL CASAC” Practice Location

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