Provider Demographics
NPI:1356361067
Name:CASSLER, SHARI A (LCSW, RPT)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:A
Last Name:CASSLER
Suffix:
Gender:F
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 S FAITH WAY
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-7372
Mailing Address - Country:US
Mailing Address - Phone:765-472-4650
Mailing Address - Fax:
Practice Address - Street 1:1907 W SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-5148
Practice Address - Country:US
Practice Address - Phone:765-456-5830
Practice Address - Fax:765-456-5142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004134A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN275614OtherVALUE OPTIONS
IN061749099TF9S4OOtherMAGELLAN
IN0007136553OtherAETNA
IN22000000368323OtherANTHEM BLUE CROSS BLUE SH
IN000000368327OtherANTHEM BLUE CROSS BLUE SH