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NPI Code Detail

MEDICARE: CASEY A DITTUS LMSW

MEDICARE: CASEY A DITTUS LMSW
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
11041C0700XClinical Social WorkerM7493MS

General Provider Information

NPI Number : 1386919264
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY A DITTUS LMSW
Provider Business Mailing Address
First Line : PO BOX 88
Second Line :
City : BRANDON
State : MS
Zip : 39043-0088
Country : US
Telephone Number : 601-824-0342
Fax Number : 601-824-0349
Provider Business Practice Location Address
First Line : 613 MARQUETTE RD
Second Line :
City : BRANDON
State : MS
Zip : 39042-3038
Country : US
Telephone Number : 601-284-0242
Fax Number : 601-824-0349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2012
Last Update Date : 03/12/2012

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Directions to “ CASEY A DITTUS LMSW” Practice Location

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