MEDICARE: KASEY M LIBBY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-25-86823	MA

General Provider Information

NPI Number	:	1316892300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASEY M LIBBY

Provider Business Mailing Address
First Line	:	405 WILLIAM ST
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-2333
Country	:	US
Telephone Number	:	781-835-8789
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 FAULKNER RD
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-3919
Country	:	US
Telephone Number	:	781-975-6027
Fax Number	:

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

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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