MEDICARE: FATOUMATA DIARIOU BAH CASAC-T

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	40607	NY

General Provider Information

NPI Number	:	1801729462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATOUMATA DIARIOU BAH CASAC-T

Provider Business Mailing Address
First Line	:	2367 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3108
Country	:	US
Telephone Number	:	212-876-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2367 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3108
Country	:	US
Telephone Number	:	212-876-2300
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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