Healthcare Provider Details

I. General information

NPI: 1497949390
Provider Name (Legal Business Name): CASEY JOHN MONROE M.S.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 E PRICE RD BLDG. B, STE 103
BROWNSVILLE TX
78521-3195
US

IV. Provider business mailing address

2414 E PRICE RD BLDG. B, STE 103
BROWNSVILLE TX
78521-3195
US

V. Phone/Fax

Practice location:
  • Phone: 956-371-2240
  • Fax: 956-548-1999
Mailing address:
  • Phone: 956-371-2240
  • Fax: 956-548-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35913
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6779-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: