Provider Demographics
NPI:1669572129
Name:CASOLARO, STEVEN A (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:CASOLARO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WALPOLE STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-762-0880
Mailing Address - Fax:781-762-6808
Practice Address - Street 1:45 WALPOLE STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-762-0880
Practice Address - Fax:781-762-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2371103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0512664Medicaid
MAW02489Medicare ID - Type UnspecifiedPSYCHOLOGY