Provider Demographics
NPI:1770226672
Name:BRACKEN, CASSAUNDRA N (LSW)
Entity Type:Individual
Prefix:MRS
First Name:CASSAUNDRA
Middle Name:N
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:CASSAUNDRA
Other - Middle Name:N
Other - Last Name:BREDBENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:509 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7402
Mailing Address - Country:US
Mailing Address - Phone:732-455-2579
Mailing Address - Fax:
Practice Address - Street 1:509 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7402
Practice Address - Country:US
Practice Address - Phone:732-455-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06476900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker