Provider Demographics
NPI:1871669176
Name:RADDER, CASEY E (LCSW)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:E
Last Name:RADDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WILER RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-9210
Mailing Address - Country:US
Mailing Address - Phone:716-830-1409
Mailing Address - Fax:
Practice Address - Street 1:3338 EAST RD
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-9684
Practice Address - Country:US
Practice Address - Phone:585-591-0400
Practice Address - Fax:585-591-0400
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070551-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker