Provider Demographics
NPI:1689336216
Name:DELILLO, CASEY MICHAEL (RADT-I)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHAEL
Last Name:DELILLO
Suffix:
Gender:M
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18663 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4161
Mailing Address - Country:US
Mailing Address - Phone:818-963-9319
Mailing Address - Fax:818-657-7440
Practice Address - Street 1:18663 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4161
Practice Address - Country:US
Practice Address - Phone:818-963-9319
Practice Address - Fax:818-657-7440
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-11
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 106H00000X, 106S00000X, 171M00000X, 101YA0400X
CAUNKNOWN164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator