Provider Demographics
NPI:1902404312
Name:JUAREZ RODRIGUEZ, CASANDRA DENIS (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:CASANDRA
Middle Name:DENIS
Last Name:JUAREZ RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 CHAR LIN DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9709
Mailing Address - Country:US
Mailing Address - Phone:919-721-4489
Mailing Address - Fax:
Practice Address - Street 1:2231 E MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-2283
Practice Address - Country:US
Practice Address - Phone:919-307-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0148031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical