Provider Demographics
NPI:1164893863
Name:SANDERS, EILEEN (CASAC-T)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 STATE ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3318
Mailing Address - Country:US
Mailing Address - Phone:845-837-1635
Mailing Address - Fax:845-837-1634
Practice Address - Street 1:671 STATE ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3318
Practice Address - Country:US
Practice Address - Phone:845-837-1635
Practice Address - Fax:845-837-1634
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)