Provider Demographics
NPI:1235439175
Name:EVANS, CASSONDRA JANE (MSW, LMSW)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:JANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969B CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2390
Mailing Address - Country:US
Mailing Address - Phone:502-619-1375
Mailing Address - Fax:502-479-9190
Practice Address - Street 1:969B CHEROKEE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2390
Practice Address - Country:US
Practice Address - Phone:502-619-1375
Practice Address - Fax:502-479-9190
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1090104100000X
KY6299104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker