Individual
GENA MARIE CHIASSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADVANCED CASAC
Contact information
Practice address
25 DIES ST, CANTON, NY 13617-1306
(315) 379-0139
(315) 379-1004
Mailing address
121 BEACH ST, MASSENA, NY 13662-1247
(315) 705-4288
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21237
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21237
OASAS
NY
Enumeration date
02/10/2012
Last updated
07/16/2019
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