Provider Demographics
NPI:1508146929
Name:VANG, CASSIDY ZE
Entity Type:Individual
Prefix:MS
First Name:CASSIDY
Middle Name:ZE
Last Name:VANG
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 1:7204 SKYWAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3280
Mailing Address - Country:US
Mailing Address - Phone:530-877-1965
Mailing Address - Fax:530-894-5791
Practice Address - Street 1:7204 SKYWAY
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3280
Practice Address - Country:US
Practice Address - Phone:530-877-1965
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 596451041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical