Provider Demographics
NPI:1942670815
Name:GUIDARELLI, CASSANDRA EMMETT (LMSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:EMMETT
Last Name:GUIDARELLI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:JOAN
Other - Last Name:EMMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1045 JAMES STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3286
Mailing Address - Country:US
Mailing Address - Phone:501-499-0471
Mailing Address - Fax:
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2730
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-04
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089420-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical