Provider Demographics
NPI:1063507846
Name:CASADY, SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:CASADY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2948 E LARK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6669
Mailing Address - Country:US
Mailing Address - Phone:417-459-3450
Mailing Address - Fax:417-885-3956
Practice Address - Street 1:1310 E KINGSLEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7216
Practice Address - Country:US
Practice Address - Phone:417-459-3450
Practice Address - Fax:417-885-3956
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical