Provider Demographics
NPI:1881383081
Name:FALLON, CASEY MAE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:MAE
Last Name:FALLON
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 1:2500 GRUBB RD STE 211
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4796
Mailing Address - Country:US
Mailing Address - Phone:302-333-6129
Mailing Address - Fax:
Practice Address - Street 1:2500 GRUBB RD STE 211
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4796
Practice Address - Country:US
Practice Address - Phone:302-333-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health