Provider Demographics
NPI:1174021828
Name:CASEY, CHARLES VINCENT
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:VINCENT
Last Name:CASEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 N INDIANA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-2756
Mailing Address - Country:US
Mailing Address - Phone:941-999-4917
Mailing Address - Fax:941-999-4908
Practice Address - Street 1:655 N INDIANA AVE UNIT A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-2756
Practice Address - Country:US
Practice Address - Phone:941-999-4917
Practice Address - Fax:941-999-4908
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst