Provider Demographics
NPI:1245749795
Name:URIBE, CASSANDRA GARCIA (LICSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:GARCIA
Last Name:URIBE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 BRIDGEPORT WAY W STE C1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4598
Mailing Address - Country:US
Mailing Address - Phone:253-355-1548
Mailing Address - Fax:
Practice Address - Street 1:3318 BRIDGEPORT WAY W STE C1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4598
Practice Address - Country:US
Practice Address - Phone:253-355-1548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605979731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical