Healthcare Provider Details

I. General information

NPI: 1144860438
Provider Name (Legal Business Name): MELISSA L CASO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BROAD ST STE 3A
SHREWSBURY NJ
07702-4216
US

IV. Provider business mailing address

11 VICTOR AVE
EATONTOWN NJ
07724-1320
US

V. Phone/Fax

Practice location:
  • Phone: 908-415-2042
  • Fax:
Mailing address:
  • Phone: 848-218-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06208200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: