Healthcare Provider Details

I. General information

NPI: 1609424852
Provider Name (Legal Business Name): CASEY LYNN VENDETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STAFFORD ROAD
BARSTOW MD
20610
US

IV. Provider business mailing address

12596 CATALINA DR
LUSBY MD
20657-4429
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4300
  • Fax:
Mailing address:
  • Phone: 443-684-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: