Healthcare Provider Details

I. General information

NPI: 1285873471
Provider Name (Legal Business Name): JARED ANDREW CASADY MA SCHOOL PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N 67TH AVE
PHOENIX AZ
85033-4517
US

IV. Provider business mailing address

3401 N 67TH AVE
PHOENIX AZ
85033-4517
US

V. Phone/Fax

Practice location:
  • Phone: 623-691-4091
  • Fax:
Mailing address:
  • Phone: 623-691-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4107310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: