Provider Demographics
NPI:1760182091
Name:TASSA, CHEYENNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:TASSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 BRYNWOOD MNR
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1709
Mailing Address - Country:US
Mailing Address - Phone:347-675-2471
Mailing Address - Fax:
Practice Address - Street 1:600 HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1139
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0880551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical