Provider Demographics
NPI:1518550524
Name:DIEUDONNE, CASSANDRA ROSE (LMSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ROSE
Last Name:DIEUDONNE
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 1:14 CORNELIA ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4805
Mailing Address - Country:US
Mailing Address - Phone:631-449-4735
Mailing Address - Fax:
Practice Address - Street 1:14 CORNELIA ST FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4805
Practice Address - Country:US
Practice Address - Phone:631-449-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110426-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker