Provider Demographics
NPI:1407001043
Name:KASSAN, AMY BETH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:KASSAN
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 1:9 FENIMORE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5720
Mailing Address - Country:US
Mailing Address - Phone:917-439-6092
Mailing Address - Fax:
Practice Address - Street 1:9 FENIMORE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5720
Practice Address - Country:US
Practice Address - Phone:917-439-6092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063747-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool