Provider Demographics
NPI:1598206500
Name:AZUERO, CASEY (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:AZUERO
Suffix:
Gender:F
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-934-3454
Mailing Address - Fax:205-934-2769
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:SRC 530
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-7330
Practice Address - Country:US
Practice Address - Phone:205-934-3454
Practice Address - Fax:205-934-2769
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical