Provider Demographics
NPI:1578630745
Name:EDWARDS, KASSANDRA BENNETT (LCSW, MFT)
Entity Type:Individual
Prefix:MS
First Name:KASSANDRA
Middle Name:BENNETT
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 PARROTT DRIVE SAN MATEO
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3048
Mailing Address - Country:US
Mailing Address - Phone:650-340-8866
Mailing Address - Fax:650-742-7135
Practice Address - Street 1:511 PARROTT DRIVE SAN MATEO
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-9440
Practice Address - Country:US
Practice Address - Phone:650-340-8866
Practice Address - Fax:650-742-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW130171041C0700X
CALCS130171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical