Provider Demographics
NPI:1356016505
Name:RECORD, CASANDRA
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:
Last Name:RECORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1014
Mailing Address - Country:US
Mailing Address - Phone:973-345-1883
Mailing Address - Fax:973-345-5480
Practice Address - Street 1:9 W BROADWAY FL 3
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1014
Practice Address - Country:US
Practice Address - Phone:973-345-1883
Practice Address - Fax:973-345-5480
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)