Provider Demographics
NPI:1972627842
Name:GORMAN, CASSANDRA MARGARET (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:MARGARET
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 E SEVEN GENERATIONS WAY
Mailing Address - Street 2:#121
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5828
Mailing Address - Country:US
Mailing Address - Phone:520-975-2028
Mailing Address - Fax:520-207-0892
Practice Address - Street 1:10501 E SEVEN GENERATIONS WAY
Practice Address - Street 2:#121
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5828
Practice Address - Country:US
Practice Address - Phone:520-975-2028
Practice Address - Fax:520-207-0892
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-122301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ136304Medicare PIN