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NPI Code Detail

MEDICARE: MR. MICHAEL TIMOTHY BUCKLEY CASAC

MEDICARE:  MR. MICHAEL TIMOTHY BUCKLEY  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) CounselorCASAC 17580NY

General Provider Information

NPI Number : 1720346406
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL TIMOTHY BUCKLEY CASAC
Provider Business Mailing Address
First Line : 449 39TH ST
Second Line : 4TH FLOOR
City : BROOKLYN
State : NY
Zip : 11232-2909
Country : US
Telephone Number : 718-871-7433
Fax Number : 718-871-7419
Provider Business Practice Location Address
First Line : 449 39TH ST
Second Line : 4TH FLOOR
City : BROOKLYN
State : NY
Zip : 11232-2909
Country : US
Telephone Number : 718-871-7433
Fax Number : 718-871-7419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2012
Last Update Date : 05/01/2012

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Directions to “ MR. MICHAEL TIMOTHY BUCKLEY CASAC” Practice Location

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