Provider Demographics
NPI:1619635133
Name:CLAYTON, KASSANDRE J (LCSW)
Entity Type:Individual
Prefix:
First Name:KASSANDRE
Middle Name:J
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KASSANDRE
Other - Middle Name:JEANETTE
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1250 E SHAW AVE APT 162
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7826
Mailing Address - Country:US
Mailing Address - Phone:559-412-2951
Mailing Address - Fax:
Practice Address - Street 1:900 QUEBEC AVENUE
Practice Address - Street 2:COMPLEX IV G-2 ROOM #153
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212
Practice Address - Country:US
Practice Address - Phone:559-992-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA814961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical