Provider Demographics
NPI:1881197036
Name:GUNTHER, CASEY MICHELLE
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MICHELLE
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MICHELLE
Other - Last Name:GOULDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3525
Mailing Address - Country:US
Mailing Address - Phone:410-822-1018
Mailing Address - Fax:
Practice Address - Street 1:300 TALBOT ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3525
Practice Address - Country:US
Practice Address - Phone:410-822-1018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22777104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker