Provider Demographics
NPI:1982064416
Name:PACHECO, CONCEPCION (CASAC)
Entity type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:MS
Other - First Name:CONCEPCION
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC
Mailing Address - Street 1:101 CEDAR ST
Mailing Address - Street 2:APT 207
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7037
Mailing Address - Country:US
Mailing Address - Phone:718-496-1589
Mailing Address - Fax:
Practice Address - Street 1:420 DOUGHTY BLVD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1357
Practice Address - Country:US
Practice Address - Phone:516-564-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6469251B00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)