Provider Demographics
NPI:1073678728
Name:CASSELL, JASON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:CASSELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 4TH PL
Mailing Address - Street 2:#4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3342
Mailing Address - Country:US
Mailing Address - Phone:917-496-9867
Mailing Address - Fax:
Practice Address - Street 1:154 W 14TH ST
Practice Address - Street 2:FOURTH FLOOR, SOUTH WING
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7307
Practice Address - Country:US
Practice Address - Phone:917-496-9867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06924511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNE6581Medicare ID - Type Unspecified