Provider Demographics
NPI:1760780092
Name:CRAVEN, CASSANDRA RAE (MT-BC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:RAE
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7608
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-0021
Mailing Address - Country:US
Mailing Address - Phone:480-965-1082
Mailing Address - Fax:480-727-9697
Practice Address - Street 1:200 EAST CURRY ROAD #307
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281
Practice Address - Country:US
Practice Address - Phone:480-965-1082
Practice Address - Fax:480-727-9697
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09398225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ195678Medicaid
AZ331210Medicaid