Provider Demographics
NPI:1063212488
Name:MBUGUA, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MBUGUA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 AMES ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2604
Mailing Address - Country:US
Mailing Address - Phone:978-677-4258
Mailing Address - Fax:
Practice Address - Street 1:26 AMES ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2604
Practice Address - Country:US
Practice Address - Phone:978-677-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician