Provider Demographics
NPI:1063629335
Name:CASANOVA, MARY ANGELA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANGELA
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2177
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-5177
Mailing Address - Country:US
Mailing Address - Phone:254-488-8409
Mailing Address - Fax:
Practice Address - Street 1:1314 N BRAZOS ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2010
Practice Address - Country:US
Practice Address - Phone:254-694-3621
Practice Address - Fax:254-694-7436
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50231104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker