Basic Information
| Provider Information | |||||||||
| NPI: | 1205273679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACASSE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | HONORIOUS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | ME.D, LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 395 | ||||||||
| Address2: | 1028 MAIN ST. | ||||||||
| City: | WARREN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010830395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134365188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2257 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137333488 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2013 | ||||||||
| LastUpdateDate: | 05/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2260 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.