Provider Demographics
NPI:1114522638
Name:CASERTA, LEIGH ANN
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:CASERTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 GEORGE KOSTAS DR STE 225
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3759
Mailing Address - Country:US
Mailing Address - Phone:304-792-1111
Mailing Address - Fax:
Practice Address - Street 1:1103 GEORGE KOSTAS DR STE 225
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3759
Practice Address - Country:US
Practice Address - Phone:304-792-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator