Provider Demographics
NPI:1457887846
Name:MOORE, CASEY (ACSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MARIE
Other - Last Name:HUDDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASEY KELLEY
Mailing Address - Street 1:101 PARKSHORE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4726
Mailing Address - Country:US
Mailing Address - Phone:916-459-8854
Mailing Address - Fax:916-404-5622
Practice Address - Street 1:101 PARKSHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:916-459-8854
Practice Address - Fax:916-404-5622
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 172V00000X
CA1327131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker