Provider Demographics
NPI:1699867150
Name:TAFT, CASEY TYLER (PHD)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:TYLER
Last Name:TAFT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:BOSTON VA MEDICAL CENTER (116-B)
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-4344
Mailing Address - Fax:857-364-4501
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:BOSTON VA MEDICAL CENTER (116-B)
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-4344
Practice Address - Fax:857-364-4501
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical