Basic Information
| Provider Information | |||||||||
| NPI: | 1538590310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARAVIA | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319208000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117434436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6319208000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2013 | ||||||||
| LastUpdateDate: | 12/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CASAC-21447 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 01556532 | 05 | NY | MEDICAID |