Provider Demographics
NPI:1821616392
Name:GARRETT, CASSANDRA JOANN
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JOANN
Last Name:GARRETT
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 1:7120 HAYVENHURST AVE STE 322
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3813
Mailing Address - Country:US
Mailing Address - Phone:818-821-0083
Mailing Address - Fax:
Practice Address - Street 1:4333 STERN AVE APT 204
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5204
Practice Address - Country:US
Practice Address - Phone:540-419-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-41222OtherBACB