Provider Demographics
NPI:1730737453
Name:SUBERO, CASEY MORGAN (LMHC, LPCC)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:MORGAN
Last Name:SUBERO
Suffix:
Gender:M
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 MENLO AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2855
Mailing Address - Country:US
Mailing Address - Phone:973-704-0613
Mailing Address - Fax:
Practice Address - Street 1:777 S FIGUEROA ST STE 810
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5813
Practice Address - Country:US
Practice Address - Phone:973-704-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008946-1101YM0800X
CA11627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty