Provider Demographics
NPI:1114619830
Name:CASELLA, MARISA ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANNE
Last Name:CASELLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:ANNE
Other - Last Name:MAZZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:15 GRUMMAN ROAD WEST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-465-4700
Mailing Address - Fax:
Practice Address - Street 1:15 GRUMMAN ROAD WEST
Practice Address - Street 2:SUITE 1000
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-465-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100073104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker