Provider Demographics
NPI:1710767660
Name:CASIGLIA, AUTUMN RENEE (LLP)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:RENEE
Last Name:CASIGLIA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 ALDERDALE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-6930
Mailing Address - Country:US
Mailing Address - Phone:586-909-7435
Mailing Address - Fax:
Practice Address - Street 1:3218 ALDERDALE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-6930
Practice Address - Country:US
Practice Address - Phone:586-909-7435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI011125103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling