=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376266999
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELYSE BRIDGET CASHER MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2022
-----------------------------------------------------
Last Update Date | 09/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 124 SAVANNAH AVE STE 1C
-----------------------------------------------------
City | STATESBORO
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30458-7149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-452-2335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7357 OLD RIVER RD S
-----------------------------------------------------
City | BROOKLET
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30415-5959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-935-1419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW008184
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------