Provider Demographics
NPI:1073788451
Name:GUMBERT, CASSIE L (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:L
Last Name:GUMBERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:CASSIE
Other - Middle Name:L
Other - Last Name:GUMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:225 CARLTON DAVIDSON LANE
Mailing Address - Street 2:
Mailing Address - City:COAL GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45638
Mailing Address - Country:US
Mailing Address - Phone:740-355-8606
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:901 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-355-8606
Practice Address - Fax:740-353-1662
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSO8OO218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health