Provider Demographics
NPI:1649746215
Name:DEWEY, CASSANDRA WHITNEY
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:WHITNEY
Last Name:DEWEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810-3636
Mailing Address - Country:US
Mailing Address - Phone:562-388-8118
Mailing Address - Fax:562-388-8117
Practice Address - Street 1:2120 W. WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:562-388-8118
Practice Address - Fax:562-388-8117
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)