Provider Demographics
NPI:1578703120
Name:MCCOLLUM, CASEY (LCSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 WOODLAND RD
Mailing Address - Street 2:PO BOX 244
Mailing Address - City:BRYN ATHYN
Mailing Address - State:PA
Mailing Address - Zip Code:19009
Mailing Address - Country:US
Mailing Address - Phone:215-527-4339
Mailing Address - Fax:
Practice Address - Street 1:2477 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:BRYN ATHYN
Practice Address - State:PA
Practice Address - Zip Code:19009
Practice Address - Country:US
Practice Address - Phone:215-527-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0164071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical