Provider Demographics
NPI:1134166481
Name:WOLFSON, CASSANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2507 MAIN AVENUE N
Mailing Address - Street 2:SUITE B
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141
Mailing Address - Country:US
Mailing Address - Phone:503-842-6400
Mailing Address - Fax:503-842-6400
Practice Address - Street 1:2507 MAIN AVENUE N
Practice Address - Street 2:SUITE B
Practice Address - City:TILLAMOOK
Practice Address - State:OR
Practice Address - Zip Code:97141
Practice Address - Country:US
Practice Address - Phone:503-842-6400
Practice Address - Fax:503-842-6400
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR29581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112936Medicare ID - Type Unspecified