MEDICARE: DIANA CASELLA LCSW

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	1041C0700X	Clinical Social Worker	8488	TN

General Provider Information

NPI Number	:	1770288391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA CASELLA LCSW

Provider Business Mailing Address
First Line	:	905 CAMELLIA DR
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-4640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 N GARDEN ST
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3288
Country	:	US
Telephone Number	:	931-774-0048
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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Directions to “ DIANA CASELLA LCSW” Practice Location

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