Provider Demographics
NPI:1023388089
Name:CASS, REBECCA S
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:CASS
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 1:147 SHAKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-3253
Mailing Address - Country:US
Mailing Address - Phone:207-324-1137
Mailing Address - Fax:207-324-5290
Practice Address - Street 1:147 SHAKER HILL RD
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:ME
Practice Address - Zip Code:04002-3253
Practice Address - Country:US
Practice Address - Phone:207-324-1137
Practice Address - Fax:207-324-5290
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME291161171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator