Provider Demographics
NPI:1982830154
Name:WYLIE, CASSANDRA CHARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:CHARLENE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:CHARLENE
Other - Last Name:CHUDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR4 BOX 2356
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-9765
Mailing Address - Country:US
Mailing Address - Phone:808-965-9206
Mailing Address - Fax:808-965-9206
Practice Address - Street 1:14-3465 GINGER RD
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-965-9206
Practice Address - Fax:808-965-9206
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3562104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker