MEDICARE: KELLY SHEERAN 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1528410438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SHEERAN CASAC

Provider Business Mailing Address
First Line	:	56 BAY ST
Second Line	:	6TH FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2563
Country	:	US
Telephone Number	:	718-808-1439
Fax Number	:	718-808-1393

Provider Business Practice Location Address
First Line	:	56 BAY ST
Second Line	:	6TH FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2563
Country	:	US
Telephone Number	:	718-808-1439
Fax Number	:	718-808-1393

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

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	07/05/2016

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Directions to “ KELLY SHEERAN CASAC” Practice Location

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