Healthcare Provider Details

I. General information

NPI: 1760276240
Provider Name (Legal Business Name): TERESA A CASIMIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 HIGH ST # 705
BOSTON MA
02110-3001
US

IV. Provider business mailing address

1507 RAVENA ST
BETHLEHEM PA
18015-9423
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-7598
  • Fax:
Mailing address:
  • Phone: 718-640-6392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001711P
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: