Provider Demographics
NPI:1801376157
Name:CASEY, NATALIE ANN (EDM)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:CASEY
Suffix:
Gender:F
Credentials:EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 CHESTNUT HILL AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4148
Mailing Address - Country:US
Mailing Address - Phone:248-880-6030
Mailing Address - Fax:
Practice Address - Street 1:6095 PINE MOUNTAIN RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3329
Practice Address - Country:US
Practice Address - Phone:678-217-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health