Gena Marie Chiasson, ADVANCED CASAC
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Canton, NY
NPI 1497028294 · NPPES record last updated Jul 16, 2019
Key facts
- NPI
- 1497028294
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 21237 (NY)
- Practice address
- 25 Dies St
Canton, NY 13617-1306 - Phone
- (315) 379-0139
- Fax
- (315) 379-1004
- NPI assigned
- Feb 10, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21237 | NY | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Country Freedom Homes, Inc. | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 21237 | NY | Yes |
Addresses
Primary practice location
25 Dies St
Canton, NY 13617-1306
Mailing address
121 Beach St
Massena, NY 13662-1247
Phone (315) 705-4288
Other practice location 1
209 Park St
Malone, NY 12953-1228
Phone (518) 483-8980
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21237 | Other | NY | OASAS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://ncfreedomhomes.org | Direct |
Other providers in Canton, NY
- Elizabeth Chapman
- Lindy L Chapman
- Judith Ann Chase
- Randyl Shane Chase
- Megan Elizabeth Chevrier
- Arthur J. Clark
- Tyler Clark
- Claxton-Hepburn Medical Center
- Mary K Coakley
- Dawn M Colbert
All providers in Canton, NY · Addiction (Substance Use Disorder) Counselor in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.