Healthcare Provider Details

I. General information

NPI: 1063359537
Provider Name (Legal Business Name): SAMANTHA DEEANN CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 CHURCH ST STE 3001
NORWICH CT
06360-5085
US

IV. Provider business mailing address

195 FITCHVILLE RD APT 4
BOZRAH CT
06334-1125
US

V. Phone/Fax

Practice location:
  • Phone: 860-425-5258
  • Fax:
Mailing address:
  • Phone: 860-382-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: