Provider Demographics
NPI:1902380728
Name:GARCIA, KASSANDRA VICTORIA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KASSANDRA
Middle Name:VICTORIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LIBERTY ST STE 218
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2577
Mailing Address - Country:US
Mailing Address - Phone:978-996-4078
Mailing Address - Fax:
Practice Address - Street 1:10 LIBERTY ST STE 218
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2577
Practice Address - Country:US
Practice Address - Phone:978-996-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120644104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker