Provider Demographics
NPI:1598894180
Name:CASELLA, DONALD A (LICSW BCD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:A
Last Name:CASELLA
Suffix:
Gender:M
Credentials:LICSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4104
Mailing Address - Country:US
Mailing Address - Phone:413-781-6485
Mailing Address - Fax:413-788-6925
Practice Address - Street 1:576 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4104
Practice Address - Country:US
Practice Address - Phone:413-781-6485
Practice Address - Fax:413-788-6925
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10153151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical