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NPI Code Detail

MEDICARE: CASEY E LUMB LICSW

MEDICARE: CASEY E LUMB LICSW
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
1101YM0800XMental Health CounselorISW02783RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ISW02783OTHERRILICSW

General Provider Information

NPI Number : 1598263626
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY E LUMB LICSW
Provider Business Mailing Address
First Line : 1992 OLD LOUISQUISSET PIKE
Second Line :
City : LINCOLN
State : RI
Zip : 02865-4590
Country : US
Telephone Number : 860-997-5417
Fax Number : 401-475-0729
Provider Business Practice Location Address
First Line : 1992 OLD LOUISQUISSET PIKE
Second Line :
City : LINCOLN
State : RI
Zip : 02865-4590
Country : US
Telephone Number : 860-997-5417
Fax Number : 401-475-0729
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2018
Last Update Date : 01/23/2018

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