Provider Demographics
NPI:1578913141
Name:CASLINE, AMY R (LSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:CASLINE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9056
Mailing Address - Country:US
Mailing Address - Phone:419-685-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:4450 BELDEN VILLAGE ST NW STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2509
Practice Address - Country:US
Practice Address - Phone:330-305-1668
Practice Address - Fax:330-305-1696
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS08004501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847496Medicaid