Provider Demographics
NPI:1184195919
Name:KIRK, CASSANDRA A (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:A
Last Name:KIRK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:A
Other - Last Name:PEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:113 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157-5211
Mailing Address - Country:US
Mailing Address - Phone:518-295-8336
Mailing Address - Fax:
Practice Address - Street 1:113 PARK PL
Practice Address - Street 2:
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157-5211
Practice Address - Country:US
Practice Address - Phone:518-295-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0960231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical