Provider Demographics
NPI:1588374359
Name:CASEY, MICHELLE ANTOINETTE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30841 EUCLID AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3100
Mailing Address - Country:US
Mailing Address - Phone:440-516-0281
Mailing Address - Fax:440-494-7754
Practice Address - Street 1:30841 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3100
Practice Address - Country:US
Practice Address - Phone:440-516-0281
Practice Address - Fax:440-494-7756
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW.001907172V00000X
OHAPS.003693175T00000X
OHCDCA.189517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist