Provider Demographics
NPI:1003483173
Name:GERGELY, CASSANDRA KATHRYN WAYSON
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KATHRYN WAYSON
Last Name:GERGELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N 5TH ST APT 23
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19122-4472
Mailing Address - Country:US
Mailing Address - Phone:410-610-1558
Mailing Address - Fax:
Practice Address - Street 1:301 W 15TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5300
Practice Address - Country:US
Practice Address - Phone:610-619-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health