Provider Demographics
NPI:1528572997
Name:KRCMAR, CASSANDRA LEA COLUCY (LPC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEA COLUCY
Last Name:KRCMAR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-2040
Mailing Address - Country:US
Mailing Address - Phone:708-354-4547
Mailing Address - Fax:
Practice Address - Street 1:3732 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:IL
Practice Address - Zip Code:60513-1624
Practice Address - Country:US
Practice Address - Phone:708-354-4547
Practice Address - Fax:708-354-4547
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013475101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor