Provider Demographics
NPI:1093859324
Name:CASPER, RONNA MERLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:RONNA
Middle Name:MERLE
Last Name:CASPER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BICENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7738
Mailing Address - Country:US
Mailing Address - Phone:781-641-2462
Mailing Address - Fax:781-862-9545
Practice Address - Street 1:94 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6535
Practice Address - Country:US
Practice Address - Phone:781-641-2462
Practice Address - Fax:781-862-9545
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2078141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical