MEDICARE: DR. CASEY LADUKE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103G00000X	Clinical Neuropsychologist
2	103TF0200X	Forensic Psychologist
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1194172312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY LADUKE PHD

Provider Business Mailing Address
First Line	:	230 S BROAD ST STE 1005
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 S BROAD ST STE 1005
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4105
Country	:	US
Telephone Number	:	215-988-9911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/16/2025

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