Provider Demographics
NPI:1548383730
Name:CASELLA, NANCY TIENKEN I (M ED)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:TIENKEN
Last Name:CASELLA
Suffix:I
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 CITY AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3831
Mailing Address - Country:US
Mailing Address - Phone:610-642-5328
Mailing Address - Fax:610-623-3877
Practice Address - Street 1:1445 CITY AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3831
Practice Address - Country:US
Practice Address - Phone:610-642-5328
Practice Address - Fax:610-623-3877
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-001241-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist