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NPI Code Detail

MEDICARE: DEREK KENNEDY CASAC

MEDICARE: DEREK KENNEDY 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) Counselor18393NY

General Provider Information

NPI Number : 1821486622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK KENNEDY CASAC
Provider Business Mailing Address
First Line : 177 E 122ND ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2906
Country : US
Telephone Number : 212-360-7116
Fax Number :
Provider Business Practice Location Address
First Line : 177 E 122ND ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2906
Country : US
Telephone Number : 212-360-7116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2014
Last Update Date : 12/31/2014

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