Provider Demographics
NPI:1164006458
Name:CASO, MARTA D
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:D
Last Name:CASO
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 1:7210 N MANHATTAN AVE APT 1522
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3760
Mailing Address - Country:US
Mailing Address - Phone:813-447-7415
Mailing Address - Fax:
Practice Address - Street 1:7210 N MANHATTAN AVE APT 1522
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3760
Practice Address - Country:US
Practice Address - Phone:813-447-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB663835106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician