Provider Demographics
NPI:1750853099
Name:CASSATLY, SIMONA C (LPC)
Entity Type:Individual
Prefix:MS
First Name:SIMONA
Middle Name:C
Last Name:CASSATLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 ALLWOOD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1988
Mailing Address - Country:US
Mailing Address - Phone:862-930-5700
Mailing Address - Fax:973-707-2383
Practice Address - Street 1:935 ALLWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1988
Practice Address - Country:US
Practice Address - Phone:862-930-5700
Practice Address - Fax:973-707-2383
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-27
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00655000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37PC00655000OtherNJ STATE LPC