Provider Demographics
NPI:1346634672
Name:MUNGER, CASSANDRA (LIMPH LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MUNGER
Suffix:
Gender:M
Credentials:LIMPH LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4444 SOUTH 86TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 SOUTH 86TH ST
Practice Address - Street 2:STE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12112101YM0800X
172V00000X
NE3390101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026821001Medicaid