Provider Demographics
NPI:1356317788
Name:CASSELMAN, BETSY LEA (MSW - LICSW)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:LEA
Last Name:CASSELMAN
Suffix:
Gender:F
Credentials:MSW - LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3340
Mailing Address - Country:US
Mailing Address - Phone:508-655-2272
Mailing Address - Fax:
Practice Address - Street 1:14 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3340
Practice Address - Country:US
Practice Address - Phone:508-655-2272
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1036411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1561Medicare ID - Type UnspecifiedMEDICARE
MACA PO 1561Medicare UPIN