Provider Demographics
NPI:1407059124
Name:CASSERLY & ASSOCIATES PC
Entity Type:Organization
Organization Name:CASSERLY & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASSERLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:812-443-0404
Mailing Address - Street 1:508 E NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2634
Mailing Address - Country:US
Mailing Address - Phone:812-443-0404
Mailing Address - Fax:812-448-9159
Practice Address - Street 1:508 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2634
Practice Address - Country:US
Practice Address - Phone:812-443-0404
Practice Address - Fax:812-448-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040734A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty