Provider Demographics
NPI:1073885687
Name:CASEY, CAROL A (CASAC-T)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:CASEY
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 -267 PORT RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302
Mailing Address - Country:US
Mailing Address - Phone:718-981-8117
Mailing Address - Fax:718-981-9344
Practice Address - Street 1:263 -267 PORT RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10302
Practice Address - Country:US
Practice Address - Phone:718-981-8117
Practice Address - Fax:718-981-9344
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25261101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)