Provider Demographics
NPI:1689408981
Name:MCCASLIN, NICOLAS MARIO
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:MARIO
Last Name:MCCASLIN
Suffix:
Gender:M
Credentials:
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 520731
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:AK
Mailing Address - Zip Code:99652-0731
Mailing Address - Country:US
Mailing Address - Phone:907-203-1999
Mailing Address - Fax:
Practice Address - Street 1:7610 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8467
Practice Address - Country:US
Practice Address - Phone:907-206-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician