Provider Demographics
NPI:1689008286
Name:POWELL, CASSIE SARAH (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:SARAH
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:SARAH
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:4401 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1407
Mailing Address - Country:US
Mailing Address - Phone:718-304-7035
Mailing Address - Fax:
Practice Address - Street 1:4401 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1407
Practice Address - Country:US
Practice Address - Phone:718-304-7035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073380-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical