Provider Demographics
NPI:1154094449
Name:EDWARDS, CASSANDRA (MHC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 VERNON AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1419
Mailing Address - Country:US
Mailing Address - Phone:717-598-7005
Mailing Address - Fax:
Practice Address - Street 1:63-17 METROPOLITAN AVE
Practice Address - Street 2:FL 1
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1634
Practice Address - Country:US
Practice Address - Phone:718-456-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health