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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LEYLA I DITTERLIZZI CASAC (COUNSELOR II)
(718) 993-3397
Entity
Organization

Contact information

Practice address
260 E 161ST ST, BRONX, NY 10451-3512
(718) 993-3397
(718) 993-2460
Mailing address
965 PEMART AVE, PEEKSKILL, NY 10566-2213
(914) 736-1079

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
17228
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
613757
NY
Enumeration date
07/14/2010
Last updated
07/14/2010
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