Provider Demographics
NPI:1952161663
Name:CASANOVA, KATHERINE M (LCSW, DBH)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:LCSW, DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 W WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-9544
Mailing Address - Country:US
Mailing Address - Phone:520-373-4771
Mailing Address - Fax:
Practice Address - Street 1:5625 W WYOMING ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-9544
Practice Address - Country:US
Practice Address - Phone:520-373-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW218831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical