Tyrone Anthony, CASAC

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Freeport, NY

NPI 1710105945 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1710105945
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
2498 (NY)
Practice address
110 Evans Ave
Freeport, NY 11520-1435
Phone
(516) 546-4960
NPI assigned
Apr 23, 2007
Sex
Male
Sole proprietor
Yes

Medicare participation

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

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2498NYMDAddiction (Substance Use Disorder) Counselor

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 2498 NY Yes

Addresses

Primary practice location

110 Evans Ave
Freeport, NY 11520-1435

Mailing address

110 Evans Ave
Freeport, NY 11520-1435
Phone (516) 546-4960

Other providers in Freeport, NY

All providers in Freeport, NY · Addiction (Substance Use Disorder) Counselor in New York

Sources for this page

Verify at the official NPI Registry.