Provider Demographics
NPI:1093563249
Name:ALI, SYEDA (CASAC ADVANCED)
Entity type:Individual
Prefix:
First Name:SYEDA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:CASAC ADVANCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 STANLEY DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2232
Mailing Address - Country:US
Mailing Address - Phone:631-504-1648
Mailing Address - Fax:
Practice Address - Street 1:116 STANLEY DR
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2232
Practice Address - Country:US
Practice Address - Phone:631-504-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)