Provider Demographics
NPI:1346674108
Name:CASS, KIMBERLY T (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KIMBERLY
Middle Name:T
Last Name:CASS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1173
Mailing Address - Country:US
Mailing Address - Phone:315-426-5954
Mailing Address - Fax:
Practice Address - Street 1:1330 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1173
Practice Address - Country:US
Practice Address - Phone:315-426-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068823-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical