Provider Demographics
NPI:1558466789
Name:GYSEL, CARL RENE (CASAC)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:RENE
Last Name:GYSEL
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:293 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1432
Mailing Address - Country:US
Mailing Address - Phone:585-393-7701
Mailing Address - Fax:585-393-8344
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:6A
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-7701
Practice Address - Fax:585-393-8344
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11206OtherCASAC