Provider Demographics
NPI:1023791647
Name:GANZ-LEARY, CASEY LYNN (MA, LPC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LYNN
Last Name:GANZ-LEARY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:LYNN
Other - Last Name:GANZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3460 MIDVALE AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1454
Mailing Address - Country:US
Mailing Address - Phone:845-544-0241
Mailing Address - Fax:
Practice Address - Street 1:4601 MARKET ST FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4636
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional