Provider Demographics
NPI:1225304777
Name:TASKA, CASEY PALMER (MED BCBA)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:PALMER
Last Name:TASKA
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LITTON ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-1229
Mailing Address - Country:US
Mailing Address - Phone:919-260-1077
Mailing Address - Fax:
Practice Address - Street 1:111 LITTON ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1229
Practice Address - Country:US
Practice Address - Phone:919-260-1077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1119731103K00000X
NC1581103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst