Provider Demographics
NPI:1639657489
Name:BOCCASSINI, CASSANDRA RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RAE
Last Name:BOCCASSINI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BERKLEY TER
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1060
Mailing Address - Country:US
Mailing Address - Phone:201-965-9230
Mailing Address - Fax:
Practice Address - Street 1:11 BERKLEY TER
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1060
Practice Address - Country:US
Practice Address - Phone:201-965-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker