Healthcare Provider Details

I. General information

NPI: 1649281338
Provider Name (Legal Business Name): MARK CASAGRANDE L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 E. MAIN ST ONE
NEWARK DE
19711-7311
US

IV. Provider business mailing address

99 PASSMORE DR
WILMINGTON DE
19803-1548
US

V. Phone/Fax

Practice location:
  • Phone: 302-286-1402
  • Fax: 302-286-1403
Mailing address:
  • Phone: 302-478-9411
  • Fax: 302-479-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000611
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: