Provider Demographics
NPI:1730674284
Name:CASEY, JOAN BERTA
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BERTA
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-0550
Mailing Address - Country:US
Mailing Address - Phone:207-404-1081
Mailing Address - Fax:
Practice Address - Street 1:49 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2014
Practice Address - Country:US
Practice Address - Phone:207-364-7981
Practice Address - Fax:207-364-7983
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5059101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor