Healthcare Provider Details

I. General information

NPI: 1639440720
Provider Name (Legal Business Name): MARTA T CASBEER LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 4142
APO AP
96368
US

IV. Provider business mailing address

UNIT 4142
APO AP
96368
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-0433
  • Fax:
Mailing address:
  • Phone: 315-634-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9944
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: