Provider Demographics
NPI:1700035086
Name:DANFORTH, GARY JAMES (CASAC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:JAMES
Last Name:DANFORTH
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 1:16 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3802
Mailing Address - Country:US
Mailing Address - Phone:518-272-3918
Mailing Address - Fax:518-272-6391
Practice Address - Street 1:16 1ST ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3802
Practice Address - Country:US
Practice Address - Phone:518-272-3918
Practice Address - Fax:518-272-6391
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)