MEDICARE: MRS. ROBERTA LYNNE FINLEY 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	2370	NY

General Provider Information

NPI Number	:	1548540248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBERTA LYNNE FINLEY CASAC

Provider Business Mailing Address
First Line	:	620 PETER PAUL DR
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-3516
Country	:	US
Telephone Number	:	631-661-7586
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 PETER PAUL DR
Second Line	:
City	:	WEST ISLIP
State	:	NY
Zip	:	11795-3516
Country	:	US
Telephone Number	:	631-661-7586
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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