Provider Demographics
NPI:1164690558
Name:CASIMIR, BARTHOLOMEW THADDEUS (MFTI)
Entity Type:Individual
Prefix:MR
First Name:BARTHOLOMEW
Middle Name:THADDEUS
Last Name:CASIMIR
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3012
Mailing Address - Country:US
Mailing Address - Phone:415-933-6420
Mailing Address - Fax:
Practice Address - Street 1:462 21ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-3012
Practice Address - Country:US
Practice Address - Phone:415-933-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
CAIMF 62700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist