Provider Demographics
NPI:1629788971
Name:JANES, CASEY NICOLE (MA LCSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:JANES
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 LONGFIELD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1212
Mailing Address - Country:US
Mailing Address - Phone:210-896-6143
Mailing Address - Fax:
Practice Address - Street 1:1710 LONGFIELD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1212
Practice Address - Country:US
Practice Address - Phone:210-896-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX586241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX58624OtherBHEC