Individual
CASEY ROSE FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
75 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 799-3203
Mailing address
75 GRAND AVE, MASSAPEQUA, NY 11758-4905
(516) 765-6388
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
095857
NY
Other
Enumeration date
10/04/2018
Last updated
08/18/2023
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