Provider Demographics
NPI:1063625309
Name:CASACCIO, EILEEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:CASACCIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 SAINT DAVIDS RD
Mailing Address - Street 2:
Mailing Address - City:ST DAVIDS
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 CHETWYND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1453
Practice Address - Country:US
Practice Address - Phone:610-405-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical