Provider Demographics
NPI:1962031906
Name:WOOD, ROBERT DAVID (CASAC ADVANCED)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:WOOD
Suffix:
Gender:M
Credentials:CASAC ADVANCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HACADAM RD
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-3514
Mailing Address - Country:US
Mailing Address - Phone:315-941-4840
Mailing Address - Fax:
Practice Address - Street 1:2606 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6003
Practice Address - Country:US
Practice Address - Phone:315-507-5058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12990101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty