Provider Demographics
NPI:1962115634
Name:SLUSARCZYK, KASEY MARIE
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:MARIE
Last Name:SLUSARCZYK
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 1:5310 26TH ST W UNIT 1702
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-3053
Mailing Address - Country:US
Mailing Address - Phone:708-552-7404
Mailing Address - Fax:
Practice Address - Street 1:5310 26TH ST W UNIT 1702
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3053
Practice Address - Country:US
Practice Address - Phone:708-552-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst