Provider Demographics
NPI:1285055509
Name:CASPER, CAROLINE (CAROLINE)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CASPER
Suffix:
Gender:F
Credentials:CAROLINE
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:TRENCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 S BEDFORD ST APT 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2343
Mailing Address - Country:US
Mailing Address - Phone:917-692-4918
Mailing Address - Fax:
Practice Address - Street 1:85 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4015
Practice Address - Country:US
Practice Address - Phone:718-716-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-05
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087798-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker