Provider Demographics
NPI:1245451590
Name:CASELLO, ANNE (MA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CASELLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 EAST BENSON HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641
Mailing Address - Country:US
Mailing Address - Phone:520-879-2316
Mailing Address - Fax:
Practice Address - Street 1:13801 EAST BENSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641
Practice Address - Country:US
Practice Address - Phone:520-879-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ897001Medicaid