Provider Demographics
NPI:1750068821
Name:CASA, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:CASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 E 14TH ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7108
Mailing Address - Country:US
Mailing Address - Phone:718-877-6346
Mailing Address - Fax:
Practice Address - Street 1:1570 E 14TH ST APT 5A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7108
Practice Address - Country:US
Practice Address - Phone:718-877-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2663753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist