Provider Demographics
NPI:1093446494
Name:CASSEUS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CASSEUS
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 1:269 BROADWAY APT 5B
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2143
Mailing Address - Country:US
Mailing Address - Phone:917-639-6109
Mailing Address - Fax:
Practice Address - Street 1:269 BROADWAY APT 5B
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2143
Practice Address - Country:US
Practice Address - Phone:917-639-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1483487211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst