Provider Demographics
NPI:1437477833
Name:TARENTINO, CASSANDRA
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:TARENTINO
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 1:2467 RTE 10 BLDG 21-5B
Mailing Address - Street 2:
Mailing Address - City:MORRIS PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07950-1340
Mailing Address - Country:US
Mailing Address - Phone:316-655-5215
Mailing Address - Fax:
Practice Address - Street 1:2467 RTE 10 BLDG 21-5B
Practice Address - Street 2:
Practice Address - City:MORRIS PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07950-1340
Practice Address - Country:US
Practice Address - Phone:316-655-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00627000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional