Provider Demographics
NPI:1851796957
Name:WILLIAMS, CASSANDRA (PMHNP)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:AUGUSTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:625 GRAMATAN AVE APT 5L
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-1817
Mailing Address - Country:US
Mailing Address - Phone:347-264-7101
Mailing Address - Fax:
Practice Address - Street 1:625 GRAMATAN AVE APT 5L
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-1817
Practice Address - Country:US
Practice Address - Phone:347-264-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691006163W00000X
NY404549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse