Provider Demographics
NPI:1770823841
Name:CASSON, KENWAN
Entity Type:Individual
Prefix:
First Name:KENWAN
Middle Name:
Last Name:CASSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 S DUPONT HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5101
Mailing Address - Country:US
Mailing Address - Phone:302-346-5080
Mailing Address - Fax:
Practice Address - Street 1:1679 S DUPONT HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5101
Practice Address - Country:US
Practice Address - Phone:302-346-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)