Provider Demographics
NPI:1629088489
Name:CASEY, DENISE (PSYD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 BROOKMONT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2106
Mailing Address - Country:US
Mailing Address - Phone:847-382-6393
Mailing Address - Fax:
Practice Address - Street 1:1610 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1243
Practice Address - Country:US
Practice Address - Phone:847-795-3143
Practice Address - Fax:847-823-9222
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005803103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL78566Medicare ID - Type Unspecified