NPIMap

Individual provider Active NPI

Kaylie E. Deshane, CASAC

  • Addiction (Substance Use Disorder) Counselor
  • Canton, NY
National Provider Identifier
1669879060
Registry record updated Apr 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
Practice address
80 State Highway 310 Ste 1
Canton, NY 13617-1436
Phone
(315) 386-2189
Fax
(315) 386-2435
NPI assigned
Dec 1, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X NY Primary

Addresses

Primary practice location

80 State Highway 310 Ste 1
Canton, NY 13617-1436

Mailing address

80 State Highway 310
Suite 1
Canton, NY 13617
Phone (315) 386-2189

Other names 1

  • Kaylie Mousaw Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Lawrence County Past Accepting new patients
St Lawrence County Addiction (Substance Use Disorder) PastSince Aug 5, 2002 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524528000000",
    "number": "1669879060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310",
            "address_2": "SUITE 1",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "13617",
            "telephone_number": "315-386-2189",
            "fax_number": "315-386-2435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 STATE HIGHWAY 310 STE 1",
            "city": "CANTON",
            "state": "NY",
            "postal_code": "136171436",
            "telephone_number": "315-386-2189",
            "fax_number": "315-386-2435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHANE",
        "first_name": "KAYLIE",
        "middle_name": "E.",
        "name_prefix": "Ms.",
        "credential": "CASAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-01",
        "last_updated": "2018-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLIE",
            "last_name": "MOUSAW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Canton, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.