Provider Demographics
NPI:1629137955
Name:MARCEAU, STEPHEN P (CASAC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:MARCEAU
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 1:236 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-3903
Mailing Address - Country:US
Mailing Address - Phone:518-483-7618
Mailing Address - Fax:
Practice Address - Street 1:209 PARK ST.
Practice Address - Street 2:CITIZEN ADVOCATES
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953
Practice Address - Country:US
Practice Address - Phone:518-483-8980
Practice Address - Fax:518-483-4830
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 4525101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)