Provider Demographics
NPI:1821516832
Name:CIRA, CASSANDRA SUZANNE
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:SUZANNE
Last Name:CIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MALTON RD
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-2001
Mailing Address - Country:US
Mailing Address - Phone:906-485-2347
Mailing Address - Fax:906-486-1150
Practice Address - Street 1:100 MALTON RD
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-2001
Practice Address - Country:US
Practice Address - Phone:906-485-2347
Practice Address - Fax:906-486-1150
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)