Provider Demographics
NPI:1710444179
Name:CASEY, DANIELLE (MED)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:CASEY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 WASHINGTON AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-2935
Mailing Address - Country:US
Mailing Address - Phone:504-321-3767
Mailing Address - Fax:
Practice Address - Street 1:4035 WASHINGTON AVE STE 105
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70125-2935
Practice Address - Country:US
Practice Address - Phone:504-321-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1Medicaid