Provider Demographics
NPI:1255646105
Name:KELLY, CASANDRA JOYCE (LCSW)
Entity type:Individual
Prefix:
First Name:CASANDRA
Middle Name:JOYCE
Last Name:KELLY
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 1:7221 W 79TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2906
Mailing Address - Country:US
Mailing Address - Phone:913-444-0083
Mailing Address - Fax:
Practice Address - Street 1:7221 W 79TH ST STE 105
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2906
Practice Address - Country:US
Practice Address - Phone:913-444-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090023591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical