Provider Demographics
NPI:1508527953
Name:KHAN, CASSIDY A (LMSW)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:A
Last Name:KHAN
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 1:121 FISHER AVE APT F1
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2615
Mailing Address - Country:US
Mailing Address - Phone:917-391-8691
Mailing Address - Fax:
Practice Address - Street 1:121 FISHER AVE APT F1
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2615
Practice Address - Country:US
Practice Address - Phone:917-391-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1099681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical