Provider Demographics
NPI:1417047754
Name:KASSINGER, KATHLEEN A (LISW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:KASSINGER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KASSINGER-WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:96 GRAHAM ROAD
Mailing Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-929-1326
Mailing Address - Fax:330-929-1327
Practice Address - Street 1:96 GRAHAM ROAD
Practice Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-929-1326
Practice Address - Fax:330-929-1327
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00074831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKASW24301Medicare ID - Type Unspecified