Provider Demographics
NPI:1619906799
Name:LEUTZINGER, CASSIE JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:JO
Last Name:LEUTZINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7294 CLOISTER DR APT 7
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8082
Mailing Address - Country:US
Mailing Address - Phone:402-580-0516
Mailing Address - Fax:941-761-5615
Practice Address - Street 1:3914 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9059
Practice Address - Country:US
Practice Address - Phone:941-756-1200
Practice Address - Fax:941-739-9358
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9216103TC0700X
NE625103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID582ZMedicare UPIN
NE246564OtherMIDLANDS CHOICE
NE470798717OtherTRIWEST
NED08488OtherBCBS
NEQ49302Medicare UPIN
NE10024969000Medicaid
NE246564OtherMIDLANDS CHOICE
NE10024968900Medicaid
NED08488OtherBCBS
NE470798717-29Medicaid