Provider Demographics
NPI:1386071959
Name:ADAMS, WAYNE O (CASAC-T)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:O
Last Name:ADAMS
Suffix:
Gender:M
Credentials:CASAC-T
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:O
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16345 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3026
Mailing Address - Country:US
Mailing Address - Phone:212-533-8400
Mailing Address - Fax:212-763-0599
Practice Address - Street 1:8 E 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8908
Practice Address - Country:US
Practice Address - Phone:212-533-8400
Practice Address - Fax:212-763-0599
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13-2602882Medicaid