Provider Demographics
NPI:1881713279
Name:CASEY, ANN ELIZABETH (MSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:CASEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3859
Mailing Address - Country:US
Mailing Address - Phone:781-662-5360
Mailing Address - Fax:781-662-5393
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3859
Practice Address - Country:US
Practice Address - Phone:781-662-5360
Practice Address - Fax:781-662-5393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1043211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO4155Medicare ID - Type Unspecified