Basic Information
| Provider Information | |||||||||
| NPI: | 1619955028 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASENAVE | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2124 RESEARCH ROW | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Practice Location | |||||||||
| Address1: | 2124 RESEARCH ROW | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812529993 | ||||||||
| FaxNumber: | 2812529997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 12/05/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 24413 | TX | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |
No ID Information.