Provider Demographics
NPI:1124262456
Name:CASKEY, VANESSA P (PSYD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:P
Last Name:CASKEY
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 1:4725 44TH ST
Mailing Address - Street 2:1F
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-6586
Mailing Address - Country:US
Mailing Address - Phone:646-491-2258
Mailing Address - Fax:
Practice Address - Street 1:412 AVENUE OF THE AMERICAS STE 705
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:646-491-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020756-1103TC0700X, 103TC2200X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist