Provider Demographics
NPI:1891447637
Name:RUSS, CASSIE (MSW)
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:
Last Name:RUSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARK WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-6605
Mailing Address - Country:US
Mailing Address - Phone:707-349-3803
Mailing Address - Fax:
Practice Address - Street 1:6945 OLD HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9381
Practice Address - Country:US
Practice Address - Phone:707-262-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical