Provider Demographics
NPI:1558074005
Name:DRANE, CASSONDRA
Entity Type:Individual
Prefix:
First Name:CASSONDRA
Middle Name:
Last Name:DRANE
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 1:9119 N 7TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2598
Mailing Address - Country:US
Mailing Address - Phone:480-296-2054
Mailing Address - Fax:
Practice Address - Street 1:9119 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2598
Practice Address - Country:US
Practice Address - Phone:480-296-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician