Provider Demographics
NPI:1821127465
Name:CASEY, SUSAN JOY (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JOY
Last Name:CASEY
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 FRANKLIN AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-433-6054
Mailing Address - Fax:516-433-6054
Practice Address - Street 1:1527 FRANKLIN AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-433-6054
Practice Address - Fax:516-433-6054
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02661011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN51651Medicare ID - Type Unspecified