Provider Demographics
NPI:1710253828
Name:CASAROTTO, CONSUELO (LAC)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:CASAROTTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:245 CARLTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-4001
Mailing Address - Country:US
Mailing Address - Phone:347-743-5623
Mailing Address - Fax:949-543-2449
Practice Address - Street 1:368 BROADWAY STE 501
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3937
Practice Address - Country:US
Practice Address - Phone:347-743-5623
Practice Address - Fax:949-543-2449
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004564-1171100000X
NY004564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist