Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 19817 | NY |
NPI | 1003989393 |
---|---|
Provider Name | Ann-Marie Caruso |
First Address | Sanborn, NY 14132-9014 |
Second Address | Sanborn, NY 14132-9014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19817 | CASAC-T (01) | NY |