Basic Information
| Provider Information | |||||||||
| NPI: | 1376617878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASERTA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 917770 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328917770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139743519 | ||||||||
| FaxNumber: | 8139742478 | ||||||||
| Practice Location | |||||||||
| Address1: | 12901 BRUCE B DOWNS BLVD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336124742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139743519 | ||||||||
| FaxNumber: | 8139742478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 04/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME 100190 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 280229500 | 05 | FL | MEDICAID | 09130 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |