Provider Demographics
NPI:1225475882
Name:KOSTENDT, CASSANDRA OMARA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:OMARA
Last Name:KOSTENDT
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 1:541 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2840
Mailing Address - Country:US
Mailing Address - Phone:760-583-2524
Mailing Address - Fax:
Practice Address - Street 1:541 LEDGE ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2840
Practice Address - Country:US
Practice Address - Phone:760-583-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health