Provider Demographics
NPI:1770020802
Name:CASSARA, KATRINA ROSE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:ROSE
Last Name:CASSARA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:SODERLUND-PAVON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QBA
Mailing Address - Street 1:11218 PRADO DEL REY LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3921
Mailing Address - Country:US
Mailing Address - Phone:702-503-2841
Mailing Address - Fax:
Practice Address - Street 1:2121 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2205
Practice Address - Country:US
Practice Address - Phone:702-382-7746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner