Provider Demographics
NPI:1598001158
Name:CASAREZ, SARA (LCSWA, ITFS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CASAREZ
Suffix:
Gender:F
Credentials:LCSWA, ITFS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 S 3RD ST
Mailing Address - Street 2:APT 201
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4130 OLEANDER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6843
Practice Address - Country:US
Practice Address - Phone:910-794-3929
Practice Address - Fax:910-798-2303
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC222Q00000X
NCP0083941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist