Provider Demographics
NPI:1437762432
Name:VELARDO, KASSANDRA A
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:A
Last Name:VELARDO
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 1:103 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TUNNEL HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30755-9733
Mailing Address - Country:US
Mailing Address - Phone:707-372-5202
Mailing Address - Fax:
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4759
Practice Address - Country:US
Practice Address - Phone:470-361-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-132676106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician