Provider Demographics
NPI:1164891768
Name:CASSETTY, CASEY LARAE (LCSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:LARAE
Last Name:CASSETTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LARAE
Other - Last Name:COURSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 RIVERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1635
Mailing Address - Country:US
Mailing Address - Phone:270-935-3441
Mailing Address - Fax:
Practice Address - Street 1:1830 DESTINY LN STE 105
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1088
Practice Address - Country:US
Practice Address - Phone:270-746-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73621041C0700X
KY2536131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical