Provider Demographics
NPI:1073062253
Name:MADIGAN, KASSANDRA ENID (CASAC-T)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:ENID
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:ENID
Other - Last Name:BAECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:55 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4436
Mailing Address - Country:US
Mailing Address - Phone:631-920-8000
Mailing Address - Fax:
Practice Address - Street 1:55 HORIZON DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4436
Practice Address - Country:US
Practice Address - Phone:631-920-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34447101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program