MEDICARE: MR. NELSON LASSALLE LMSW, 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	17796	NY
2	101YM0800X	Mental Health Counselor	073043	NY

General Provider Information

NPI Number	:	1851678700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NELSON LASSALLE LMSW, CASAC

Provider Business Mailing Address
First Line	:	27 RED OAKS MILL ROAD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3262
Country	:	US
Telephone Number	:	646-671-7017
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 RED OAKS MILL ROAD
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3262
Country	:	US
Telephone Number	:	646-671-7017
Fax Number	:

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

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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