Individual
RANDYL SHANE CHASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 STATE HIGHWAY 310 STE 1, CANTON, NY 13617-1493
(315) 386-2189
Mailing address
136 WILSON ST, GOUVERNEUR, NY 13642-3270
(315) 573-6689
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
35354
NY
Other
Enumeration date
06/03/2019
Last updated
06/03/2019
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