Most Relevant Information
Provider Data
| NPI Number: | 1003560947 |
| Provider Name: | JOSE M FONSECA CASAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 20930 |
Most Important Dates
| Enumeration Date: | 02/09/2022 |
| Last Updated: | 02/09/2022 |
Provider Practice Location
1776 CLAY AVE
BRONX
NY
104577299
Practice Location Phone/Fax
| Phone: | 7189607599 |
| Fax: |
Provider Mailing Location
311 E 175TH ST
BRONX
NY
104575848
Provider Mailing Phone/Fax
| Phone: | 7189607568 |
| Fax: |