Provider Demographics
NPI:1538735923
Name:PASEMAN, WALLACE WILLIAM (CASAC-2)
Entity type:Individual
Prefix:
First Name:WALLACE
Middle Name:WILLIAM
Last Name:PASEMAN
Suffix:
Gender:M
Credentials:CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 36TH ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4546
Mailing Address - Country:US
Mailing Address - Phone:917-371-9933
Mailing Address - Fax:
Practice Address - Street 1:2261 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6486
Practice Address - Country:US
Practice Address - Phone:347-505-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)