Provider Demographics
NPI:1043835366
Name:CASELLA, EMILY ELIZABETH
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:CASELLA
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 1:76 MOKEMA AVE
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0840
Mailing Address - Country:US
Mailing Address - Phone:781-298-1480
Mailing Address - Fax:
Practice Address - Street 1:76 MOKEMA AVE
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0840
Practice Address - Country:US
Practice Address - Phone:781-298-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician