Provider Demographics
NPI:1689218059
Name:CASEY, MIRANDA LYNNZEY (LICSW)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LYNNZEY
Last Name:CASEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 EDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1224
Mailing Address - Country:US
Mailing Address - Phone:256-504-5921
Mailing Address - Fax:
Practice Address - Street 1:6 OFFICE PARK CIR STE 304
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2786
Practice Address - Country:US
Practice Address - Phone:205-883-9736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4583C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical