Provider Demographics
NPI:1114359007
Name:HANDY, DOUGLAS (CASAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HANDY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3320
Mailing Address - Country:US
Mailing Address - Phone:518-272-3918
Mailing Address - Fax:518-272-2149
Practice Address - Street 1:1724 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3320
Practice Address - Country:US
Practice Address - Phone:518-272-3918
Practice Address - Fax:518-272-2149
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)