Provider Demographics
NPI:1578927455
Name:ROMO, CASSANDRA
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:ROMO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASSIE
Other - Middle Name:MARIE
Other - Last Name:ROMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:47785
Mailing Address - Street 1:529 FARIA ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4829
Mailing Address - Country:US
Mailing Address - Phone:925-642-2448
Mailing Address - Fax:
Practice Address - Street 1:529 FARIA ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4829
Practice Address - Country:US
Practice Address - Phone:925-642-2448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47758104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker