Provider Demographics
NPI:1003087297
Name:CASAMO, PATRICIA ANNE (L C S W)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANNE
Last Name:CASAMO
Suffix:
Gender:F
Credentials:L C S W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5650
Mailing Address - Country:US
Mailing Address - Phone:908-791-9341
Mailing Address - Fax:908-791-9001
Practice Address - Street 1:5 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5650
Practice Address - Country:US
Practice Address - Phone:908-791-9341
Practice Address - Fax:908-791-9001
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC017401041C0700X
NY1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA649467Medicare UPIN