Provider Demographics
NPI:1295789980
Name:CASEY, PATRICK T (PHD)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:T
Last Name:CASEY
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 1:8941 MARMORA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2448
Mailing Address - Country:US
Mailing Address - Phone:312-781-2850
Mailing Address - Fax:
Practice Address - Street 1:1603 ORRINGTON AVE STE 602
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3841
Practice Address - Country:US
Practice Address - Phone:312-781-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010802103TC0700X
MI6301010565103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100383345AMedicaid
MI5170415Medicaid
IN100383345AMedicaid
MI5170415Medicaid
MI0C96065044Medicare PIN