Doctor Name: | DR. EILEEN CASACCIO |
NPI Number: | 1063625309 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | PS015123 |
Business Practice Address: | 100 Chetwynd Dr Suite 102 Bryn Mawr, PA - 190101453 |
Business Phone Number: | 6104055220 |
Business Fax Number: | |
Mailing Address: | 423 Saint Davids Rd, ST DAVIDS |
State: | PA |
Postal Code: | 190874309 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PS015123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |