Basic Information
| Provider Information | |||||||||
| NPI: | 1154636330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | MARY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021452511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606906959 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14 FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | ALLSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021343006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177826460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.