Provider Demographics
NPI:1023895166
Name:FISH, CASEY JANE (LLMSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:JANE
Last Name:FISH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:ELLIOT
Other - Middle Name:JANE
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW
Mailing Address - Street 1:224 S ADAMS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5572
Mailing Address - Country:US
Mailing Address - Phone:586-899-4653
Mailing Address - Fax:586-899-4653
Practice Address - Street 1:224 S ADAMS ST APT 1
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5572
Practice Address - Country:US
Practice Address - Phone:586-899-4653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68511200711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker