Provider Demographics
NPI:1932477718
Name:THOR, KA CASSANDRA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KA
Middle Name:CASSANDRA
Last Name:THOR
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 1:340 MAIN ST STE 818
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1692
Mailing Address - Country:US
Mailing Address - Phone:508-791-4976
Mailing Address - Fax:508-398-4659
Practice Address - Street 1:101 MELROSE ST APT 1
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-6503
Practice Address - Country:US
Practice Address - Phone:978-353-9446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS79883471OtherDRIVER LICENSE