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NPI Code Detail

MEDICARE: CASEY MAIDEL

MEDICARE: CASEY MAIDEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.165833OH

General Provider Information

NPI Number : 1063929958
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY MAIDEL
Provider Business Mailing Address
First Line : 213 E CHESTNUT ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-3404
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 213 E CHESTNUT ST
Second Line :
City : MOUNT VERNON
State : OH
Zip : 43050-3404
Country : US
Telephone Number : 740-326-9255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2018
Last Update Date : 04/10/2018

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Directions to “ CASEY MAIDEL ” Practice Location

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