Provider Demographics
NPI:1275035446
Name:BOLTON, CASSANDRE (LCSW-C, LICSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRE
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:CASSANDRE
Other - Middle Name:
Other - Last Name:MARTELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C, LICSW
Mailing Address - Street 1:9584 MUIRKIRK RD APT T2
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2843
Mailing Address - Country:US
Mailing Address - Phone:917-514-4676
Mailing Address - Fax:
Practice Address - Street 1:9584 MUIRKIRK RD APT T2
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2843
Practice Address - Country:US
Practice Address - Phone:917-514-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical